Bacterial DNA detection in very preterm infants assessed for risk of early onset sepsis

Abstract Objectives The aim of this study is to evaluate the diagnostic ability of multiplex real-time polymerase chain reaction (PCR) in very preterm infants assessed for risk of early onset neonatal sepsis (EOS). Methods Prospective observational cohort study. Blood samples of preterm neonates ≤32 weeks of gestation were evaluated by commercial multiplex real-time PCR within 2 h after delivery. The definition of EOS was based on positive blood culture and clinical signs of infection or negative blood culture, clinical signs of infection and abnormal neonatal blood count and serum biomarkers. Results Among 82 subjects analyzed in the study, 15 had clinical or confirmed EOS. PCR was positive in four of these infants (including the only one with a positive blood culture), as well as in 15 of the 67 infants without sepsis (sensitivity 27%, specificity 78%). Out of 19 PCR positive subjects, Escherichia coli was detected in 12 infants (63%). Statistically significant association was found between vaginal E. coli colonization of the mother and E. coli PCR positivity of the neonate (p=0.001). No relationship was found between neonatal E. coli swab results and assessment findings of bacterial DNA in neonatal blood stream. Conclusions Multiplex real-time PCR had insufficient diagnostic capability for EOS in high risk very preterm infants. The study revealed no significant association between PCR results and the diagnosis of clinical EOS. Correlation between maternal vaginal swab results and positive PCR in the newborn needs further investigation to fully understand the role of bacterial DNA analysis in preterm infants.

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Targeting glucose control in preterm infants: pilot studies of continuous glucose monitoring

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2018-314814 ◽

2018 ◽

pp. fetalneonatal-2018-314814 ◽

Cited By ~ 7

Author(s):

Lynn Thomson ◽

Daniela Elleri ◽

Simon Bond ◽

James Howlett ◽

David B Dunger ◽

...

Keyword(s):

Blood Glucose ◽

Real Time ◽

Preterm Infants ◽

Glucose Control ◽

Target Range ◽

Very Preterm Infants ◽

Very Preterm ◽

Sensor Glucose ◽

Cent Time ◽

Target Glucose

ObjectiveHyperglycaemia is common in very preterm infants and is associated with adverse outcomes. Preventing hyperglycaemia without increasing the risk of hypoglycaemia is difficult. Real time tracking with continuous glucose monitors (CGM) may improve glucose control. We assessed the feasibility and safety of CGM to target glucose control in preterm infants, to inform a randomised controlled trial (RCT).DesignWe performed a single centre study in very preterm infants during the first week of life. Accuracy was assessed by comparison of CGM with blood glucose levels (n=20 infants). In a separate pilot study of efficacy (n=20), real-time CGM combined with a paper guideline to target glucose control (2.6–10 mmol/L) was compared with standard neonatal care (masked CGM). Questionnaires were used to assess staff acceptability.ResultsNo concerns were raised about infection or skin integrity at sensor site. The sensor performed well compared with point-of-care blood glucose measurements, mean bias of −0.27 (95% CI −0.35 to −0.19). Per cent time in target range (sensor glucose 2.6–10 mmol/L) was greater with CGM than POC (77% vs 59%, respectively) and per cent time sensor glucose >10 mmol/L was less with CGM than POC (24% vs 40%, respectively). The CGM also detected clinically unsuspected episodes of hypoglycaemia. Staff reported that the use of the CGM positively improved clinical care.ConclusionsThis study suggests that CGM has sufficient accuracy and utility in preterm infants to warrant formal testing in a RCT.

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Antibiotic Susceptibility Patterns in the NICU of Ghaem Hospital of Mashhad

International Journal of Medical Laboratory ◽

10.18502/ijml.v8i1.5669 ◽

2021 ◽

Author(s):

Hassan Boskabadi ◽

Elahe Heidari ◽

Fatemeh Bagheri ◽

Maryam Zakerihamidi

Keyword(s):

Blood Culture ◽

Positive Blood Culture ◽

Neonatal Sepsis ◽

Antibiotic Susceptibility ◽

Clinical Signs ◽

High Sensitivity ◽

Signs And Symptoms ◽

Clinical Syndrome ◽

Cross Sectional ◽

E Coli

Background and Aims: Neonatal sepsis is considered a clinical syndrome characterized by signs and symptoms of infection associated with positive blood culture. The present study investigates the rate of sensitivity and resistance to antibiotics in neonates with definite sepsis. Materials and Methods: This cross-sectional study was conducted on 268 neonates with definitive sepsis (positive blood culture with clinical signs of infection) hospitalized in the NICU of Ghaem Hospital of Mashhad, from 2008 to 2018. To investigate the antibiotic susceptibility pattern, identifying microorganism and antibiogram tests was performed according to the standard microbiological method. The data were collected through a questionnaire designed by the researchers. It included neonates’ characteristics, types of microorganisms in neonatal unite, and sensitivity and resistance to neonatal sepsis’s common microorganism. Results: Based on the results, Klebsiella showed sensitivity to norfloxacin (100%), ciprofloxacin (100%), meropenem (100%), imipenem (94%), cotrimoxazole (73%), and vancomycin (67%). Similarly, Enterobacter showed 100% sensitivity to ciprofloxacin, meropenem, norfloxacin, and high sensitivity to imipenem (94%) and co-trimoxazole (83%). Acinetobacter turned out to be sensitive to co-trimoxazole and norfloxacin (both of them were 67%) and to amikacin in 33% of the cases. E. coli was sensitive to imipenem (83.33%), ciprofloxacin (80%), and ceftazidime (71.43%). Finally, staphylococcus coagulase negative was sensitive to piperacillin in 100%, vancomycin in 96.67%, and imipenem in 71.43% of the cases. Conclusions: The findings of the present study suggest that high-sensitivity drugs for the treatment of definite neonatal sepsis are Meropenem(Klebsiella and E. coli), Enterobacter(Ampicilin), Acinetobacter(Imipenem) and Staphylococcus coagulase negative (vancomycin).

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