scholarly journals Immature to Total Neutrophil (I/T) Ratio sebagai penunjang Diagnosis Sepsis Neonatorum

Author(s):  
Bastiana Bastiana ◽  
Aryati Aryati ◽  
Yulia Iriani

Early diagnosis of neonatal sepsis plays an important role in the management of patients. Blood culture, currently used as thegold standard, has several limitations such as time consuming and low positive rate. For this reason, a rapid and accurate diagnosticmethod is required. Manual differential count is a practical, inexpensive method and can support the diagnosis of bacterial infections.A shift to the left in differential white count with a raised immature neutrophil count has been documented in patients with bacterialinfections. This led to the use of I/T ratio as a indicator towards bacterial infections. The aim of this study is to obtain the diagnosticvalue of I/T ratio in diagnosing neonatal sepsis. The study was a prospective and cross-sectional. The subjects were enrolled consecutively,consisting of newborn babies (from birth to 30-days old) admitted to the Neonatal Intensive Care Unit (NICU) of the Dr. SoetomoHospital, Surabaya. Forty and three samples, consisting of 13 sepsis samples and 30 nonsepsis as controls samples were examined. I/Tratio are a ratio between immature neutrophils against total neutrophils in blood smear preparation. For the determination of the whitecell differential count, a total of 100 white cells (granulocytes) were counted. I/T ratio > 0.2 showed an abnormality that suggestaninfection process occur. Blood smear evaluations were done by three (3) independent observers. The result from three (3) observerswere as follows: sensitivity and specificity of I/T ratio in the diagnosis of neonatal sepsis were 69.2%, 92.3%, 61.5% and 50%, 50%,63.3%, respectively. Positive and negative predictive values were 37.50%, 44.44%, 42.10% and 78.94%, 93.75%, 79.16%, respectively.According to Cochran test there was no difference found between the 3 observers (p = 0.086). However, using Kappa test no agreementbetween I/T ratio and sepsis (p = 0.051) differences were found. from this study so far, the value in the diagnosis of neonatal sepsis theI/T ratio showed a low diagnostic.

2019 ◽  
Vol 70 (8) ◽  
pp. 3008-3013
Author(s):  
Silvia Maria Stoicescu ◽  
Ramona Mohora ◽  
Monica Luminos ◽  
Madalina Maria Merisescu ◽  
Gheorghita Jugulete ◽  
...  

Difficulties in establishing the onset of neonatal sepsis has directed the medical research in recent years to the possibility of identifying early biological markers of diagnosis. Overdiagnosing neonatal sepsis leads to a higher rate and duration in the usage of antibiotics in the Neonatal Intensive Care Unit (NICU), which in term leads to a rise in bacterial resistance, antibiotherapy complications, duration of hospitalization and costs.Concomitant analysis of CRP (C Reactive Protein), procalcitonin, complete blood count, presepsin in newborn babies with suspicion of early or late neonatal sepsis. Presepsin sensibility and specificity in diagnosing neonatal sepsis. The study group consists of newborns admitted to Polizu Neonatology Clinic between 15th February- 15th July 2017, with suspected neonatal sepsis. We analyzed: clinical manifestations and biochemical markers values used for diagnosis of sepsis, namely the value of CRP, presepsin and procalcitonin on the onset day of the disease and later, according to evolution. CRP values may be influenced by clinical pathology. Procalcitonin values were mainly influenced by the presence of jaundice. Presepsin is the biochemical marker with the fastest predictive values of positive infection. Presepsin can be a useful tool for early diagnosis of neonatal sepsis and can guide the antibiotic treatment. Presepsin value is significantly higher in neonatal sepsis compared to healthy newborns (939 vs 368 ng/mL, p [ 0.0001); area under receiver operating curve (AUC) for presepsine was 0.931 (95% confidence interval 0.86-1.0). PSP has a greater sensibility and specificity compared to classical sepsis markers, CRP and PCT respectively (AUC 0.931 vs 0.857 vs 0.819, p [ 0.001). The cut off value for presepsin was established at 538 ng/mLwith a sensibility of 79.5% and a specificity of 87.2 %. The positive predictive value (PPV) is 83.8 % and negative predictive value (NPV) is 83.3%.


2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Raja Kannan ◽  
Suchetha S. Rao ◽  
Prasanna Mithra ◽  
B. Dhanashree ◽  
Shantharam Baliga ◽  
...  

Introduction. To evaluate Proadrenomedullin (Pro-ADM) as the diagnostic and prognostic marker in neonatal sepsis. Materials and Methods. In this cross-sectional study, Pro-ADM levels were estimated in 54 neonates with clinical sepsis and positive sepsis screen (cases) and 54 controls without clinical sepsis. Repeat Pro-ADM levels were estimated after 72 hours in cases. Pro-ADM levels were compared with the clinical outcome. Results and Discussion. Median Pro-ADM levels in cases were 31.8 (IQR: 27.8-39.4) pmol/ml which was significantly higher than controls 5.1 (IQR; 3.1-7.7) pmol/ml. From the constructed ROC curve, a value of 14.5 pmol/ml was taken as the cut-off for sepsis. Pro-ADM had 100% sensitivity, specificity, and positive predictive values (PPV) in detecting sepsis at 14.5 pmol/ml. Among cases, a decrease in Pro-ADM level by 10 pmol/ml was associated with 99% survival. Pro-ADM value of 35 pmol/ml had 100% specificity and PPV in predicting mortality. Conclusion. Pro-ADM can be used as a single biomarker for detecting neonatal sepsis, predicting clinical outcome and prognosis.


1989 ◽  
Vol 2 (1) ◽  
pp. 28-35
Author(s):  
Susan Phillips ◽  
Glenn Kaplan

Despite the remarkable technological advances in neonatal intensive care, bacterial infections continue to be a significant cause of neonatal morbidity and mortality. The clinical manifestations of sepsis are frequently subtle and nonspecific. Progression of the disease is rapid and mortality continues to be high. Antimicrobial therapy must be instituted as soon as possible after symptomatic and high risk infants are identified. Empiric broad spectrum antibiotic therapy is initiated to cover the most likely pathogens that are etiologic in neonatal sepsis. Pathogen specific therapy is guided by the isolation and identification of the infecting organism and its susceptibility patterns. The clinical status of the infant must be closely monitored, and basic supportive care provided to optimize the infants chance of survival. The emergence of drug resistance and adverse drug reaction profiles may further dictale which antimicrobial regimen is the safest and most effective. Unconventional therapies should be reserved for the most critically ill infants after conventional treatment has failed. Controlled trials of pharmacologic and nonpharmacologic treatment modalities for neonatal sepsis are needed to optimize the management of these infants.


2021 ◽  
pp. 1-3
Author(s):  
Supriya Kumari ◽  
Surya Narayan ◽  
Kumudini Jha ◽  
Debarshi Jana

Background: Chronic pelvic pain (CPP)is cyclic or noncyclic, intermittent or constant discomfort in the pelvic region for at least 6 months. It is a common complaint in female adolescents that may be overlooked. Objective: To evaluate CPP in adolescents using transvaginal ultrasound (TVS) and laparoscopy. Study design: This is a prospective cross sectional observational study conducted at Obstetrics and Gynaecology Department of Darbhanga Medical College and Hospital, Laheriasarai, Bihar. A total of 100 adolescents with CPP were evaluated by TVS and laparoscopy and findings were analyzed. Results: The mean age of adolescents was 17 ± 3.5 the majority were parous (51%), rural (69%) and low social class (65 %). Diffuse pelvic pain was present in (62%), Dysmenorrheain (61%), deep abdominal and pelvic tenderness in (55% and 80% respectively). TVS was normal in (40%) andabnormalin (60%). Laparoscopic evaluation was normal in (29%)and abnormal in(71%) in the form of tubo- ovarian masses (19%),endometriosis (18%) ovarian cysts (9%), adenomyosis (8%), Adhesions (6%), PID and RVF uterus (4% for each), subserous fibroid and pelvic congestion (1% for each). sensitivity and specificity of TVS were (81.7% and 93.1% respectively). Positive and negative predictive values were 96.7% and 67.5% respectively. Kappa test between TVS and laparoscopy showed good agreement (kappa = 0.67). Conclusions: Good agreement was found between TVS and laparoscopy, however, laparoscopy is considered as a gold standard tool in evaluating adolescent CPP because of distinct advantages in terms of sensitivity and negative predictive value.


2017 ◽  
Vol 24 (10) ◽  
pp. 1455-1460
Author(s):  
Nazia Bashir Abbasi ◽  
Nighat Jabeen ◽  
Shafat Khatoon

Introduction: Neonatal sepsis is a systemic condition characterized bybacteremia that occurs in the first month of life. It is a fatal condition and need to be treatedpromptly. Bacterial isolates include both gram positive and negative bacteria and the cureof condition is highly dependent on antimicrobial drug sensitivity and resistant patterns. It isthere for utmost important to known commonly occurring bacteria in neonatal septic statesand their drug sensitivity patterns. Objectives: To determine the frequency of the bacterialisolates in blood and their sensitivity patterns to commonly used antibiotics in neonatal sepsis.Setting: Neonatal intensive care unit(NICU), Department of Shifa International Hospital. (SIH),Islamabad. Study Design: Cross sectional. Duration: This study was conducted between 6 1stJune 2013 to 30th November 2013. Subject and Methods: A total of 180 neonates, admittedin NICU with evidence of clinical sepsis i.e. with signs and symptoms suggestive of septicemia(fever, lethargy, reluctance to feed, seizures, and irritability) were included in this study. Thesamples for blood cultures were taken. Identification of bacterial isolates was carried out by thestandard bacteriological techniques, which include gram staining and bacterial cultures andantimicrobial sensitivity patterns which was performed by modified Kirby and Bauer disc diffusemethod as per CLSI (Clinical and Laboratory StandardsInstitute)guidelines.A predesignedPerforma was filled. Results: Culture revealed bacterial growth in 7.2% samples. Gram negativeorganisms were observed in 6.67% and only 1 were gram positive. In this study, 50% and 100%of E-coli were sensitive to ampicillin, meropenem and amikacin, gentamycin respectively. Sixtyto 100% of pseudomonas was sensitive to ceftazidime, tazobactum, meropenem and 100%of enterococcus was sensitive to ampicillin and vancomycin. Conclusion: Antimicrobial drugresistance and constantly changing resistance patterns is emerging issues in various groupsof infections and septic states, especially for routinely used antibiotics as found in our study.Thus by prescribing rational use of antimicrobial as per bactriogram, It‘ll be easier totreat sepsiseffectively and economically and reduce the mortality and morbidity related to neonatal sepsis.


2020 ◽  
Vol 58 (231) ◽  
Author(s):  
Brajesh Raj Chaudhary ◽  
Kalpana Karmacharya Malla ◽  
Sajan Poudel ◽  
Brajesh Kumar Jha

Introduction: Neonatal sepsis is a major cause of neonatal morbidity and mortality worldwide, especially in developing countries like Nepal. Antibiotic resistance among microorganisms poses new challenges in the treatment of neonatal sepsis. The present study is conducted with the objectives of determining clinico-bacteriological profile and antibiotic susceptibility among isolated bacteria in a neonatal intensive care unit. Methods: A descriptive cross-sectional study was conducted from January 1, 2017, to December 31, 2019, in the neonatal intensive care unit of a tertiary care hospital after obtaining ethical clearance from Institutional Review Committee (Reference Number: 2020-064). The sample size was calculated and 77 neonates with culture-proven sepsis were included in the study. The antibiotic susceptibility tests of the isolates were done by Kirby-Bauer disc diffusion method. Data entry was done in Statistical Packages for the Social Sciences version 20. Results: Of the 841 specimens (blood, cerebrospinal fluid, urine, tracheal aspirate and pus) processed for culture, bacteria were isolated in 84 (10.0%) specimens. Among the 84, gram-negative bacilli were the predominant isolates 76 (90.5%); of which Acinetobacter baumannii was the most common 27 (32.1%). Both the Gram-negative and the Gram-positive bacteria showed high resistance to Penicillin and Cephalosporins. Gram-negative bacteria showed maximum sensitivity to Colistin, Carbapenems, Tigecycline and Fluoroquinolones. Gram-positive bacteria showed maximum susceptibility to Amikacin, Vancomycin and Carbapenems. Conclusions: Judicious use of antibiotics based on the updated knowledge of prevalent organisms in the local hospital setting and their antibiotic sensitivity pattern is of utmost importance for the effective treatment of neonatal sepsis.


2013 ◽  
Vol 52 (192) ◽  
Author(s):  
Badri Thapa ◽  
Anurag Thapa ◽  
Dhan Raj Aryal ◽  
Kusum Thapa ◽  
Asha Pun ◽  
...  

Introduction: Neonatal sepsis causes high morbidity and mortality of newborns. The study aims to study the predictors and clinical, haematological and bacteriological factors of neonatal sepsis. Methods: A descriptive cross sectional study was conducted in a Neonatal Intensive Care Unit (NICU) of Paropakar Maternity and Women’s Hospital in Kathmandu between October and December 2011. Demographic, obstetrics, clinical and microbiological data were studied for 300 neonates. Results: The NICU prevalence rate of sepsis was 37.12%. Early onset neonatal sepsis was common (91.39%) (P=0.000). Cesarean section (OR 1.95, 95% CI 1.15-3.31), apgar score <4 at 1 min (P=0.00) and <7 at 5 min of birth (P=0.00) predicted sepsis. Neonates with sepsis were more likely to present with hypothermia (OR 1.180, 95% CI 0.080-17.214), pustules (OR 2.188, 95% CI 0.110-43.465), dehydration (OR 3.040, 95% CI 0.170-54.361), diminished movement (OR 3.082, 95% CI 0.433-21.950) and bulging fontanels (OR 16.464, 95% CI 0.007-41495.430). Coagulase negative Staphylococcus spp. (CoNS) (21, 41.17%) was most common pathogen of neonatal sepsis. Variable antibiotic resistance patterns of isolates with emergence of meropenem resistance in Pseudomonas spp. and methicillin resistance in CoNS and S. aurues were noted. Mortality due to sepsis was highest (15, 8.06%) among total mortalities (21, 11.29%). Conclusions: Delivery via cesarian section, apgar score <4 at 1 min, and <7 at 5 min predicted sepsis. Morbidity and mortality of neonatal sepsis was common in this setting and early maternal and neonatal interventions are required to address this issue. Keywords: morbidity; mortality; neonatal sepsis; predictors.


e-CliniC ◽  
2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Tesalonika Kereh ◽  
Rocky Wilar ◽  
Suryadi N. N. Tatura

Abstract: Neonatal sepsis is defined as a clinical syndrome with systemic manifestations and bacteremia that occurs in the first month of life. Admnistration of antibiotics had to follow the pattern of the most common causal germs in a hospital. This study was aimed to determine the antibiotics of neonatal sepsis patients at the Neonatal Intensive Care Unit (NICU) of Prof. Dr. R. D. Kandou Hospital Manado, in this case types of antibiotics, duration of the used antibiotics, as well as the use of the first, second, and third-line antibiotics. This was a descriptive analytical study with a cross sectional design. Samples were neonatal sepsis patients who were treated with first, second, and third line antibiotic therapy at the NICU from September to November 2019. The results obtained a total of 40 patients, consisting of 22 males (55%) and 18 females (45%). The condition of the patients when coming out of the ward were 12 recovered (30%) and 28 died (70%). Combination antibiotics were the most common used as many as 37 cases (58%). The length of time using antibiotics based on lines, obtained that the first-line antibiotics were given at a duration of ≤5 days, while the second and third line antibiotics were more often given at a duration of >5 days. In conclusion, most neonatal sepsis patients were given antibiotics in combination. There were differences among the durations of the first, second and third line antibiotics used in patients with neonatal sepsis.Keywords: neonatal sepsis, antibiotics Abstrak: Sepsis neonatorum didefinisikan sebagai sindrom klinis dengan manifestasi sistemik dan bakterimia yang terjadi pada satu bulan pertama kehidupan. Pemberian antibiotik harus memperhatikan pola kuman penyebab tersering yang ada di suatu rumah sakit. Penelitian ini bertujuan untuk mengetahui penggunaan antibiotik pada pasien sepsis neonatorum di Neonatal Intensive Care Unit (NICU) RSUP Prof. Dr. R. D. Kandou Manado dalam hal ini jenis-jenis antibiotik yang digunakan, durasi penggunaan antibiotik yang diberikan, serta penggunaan antibiotik lini pertama, kedua, dan ketiga. Jenis penelitian ialah deskriptif analitik dengan desain potong lintang. Sampel penelitian ialah pasien sepsis neonatorum yang menggunakan terapi antibiotik lini pertama, kedua, dan ketiga yang dirawat di ruangan NICU periode September - November 2019. Hasil penelitian memperoleh total 40 pasien, terdiri dari 22 bayi laki-laki (55%) dan 18 bayi perempuan (45%). Keadaan pasien saat keluar dari ruang rawat 12 sembuh (30%) dan 28 meninggal (70%). Penggunaan antibiotik kombinasi paling banyak digunakan yaitu sebanyak 37 kasus (58%). Lama waktu penggunaan antibiotik berdasarkan lini, didapatkan antibiotik lini pertama paling banyak diberikan pada durasi ≤5 hari, sedangkan lini kedua dan ketiga lebih sering diberikan pada durasi >5 hari. Simpulan penelitian ini ialah sebagian besar pasien sepsis neonatorum diberikan antibiotik secara kombinasi. Terdapat perbedaan pada lama waktu penggunaan antibiotik pasien sepsis neonatorum baik lini pertama, kedua dan ketiga.Kata kunci: sepsis neonatorum, antibiotik


2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Hassan Boskabadi ◽  
Ali Moradi ◽  
Asal Ramazani ◽  
Maryam Zakerihamidi

Background: Sepsis is a major neonatal disease that requires appropriate early treatment. Objectives: The current study aimed to determine the resistance and sensitivity to antibiotics in neonates admitted to the neonatal intensive care unit (NICU) due to sepsis. Methods: In this cross-sectional study, 268 neonates with definitive sepsis (positive blood culture with clinical signs of infection) hospitalized during 2009-2019 are investigated. Identification of microorganism and antibiogram test were performed according to the standard microbiological method. Antibiotics susceptibility testing was performed by disk diffusion and microdilution method according to Clinical and Laboratory Standards Institute (CLSI) (2013). A researcher-made questionnaire, including characteristics of neonates and types of microorganisms (gram-positive or negative) in the neonatal ward, as well as sensitivity and resistance to common microorganisms in neonatal sepsis, was used to collect data. Results: According to the antibiogram results, the microorganism found in NICU showed sensitivity to vancomycin (97%), imipenem (71%), and co-trimoxazole (56%), as well as Norfloxacin, Cephalotin, and Cefazolin (50%). Gram-negative bacteria showed complete sensitivity (100%) to Piperacillin, Clavulanic acid, Colistin, Tazobactam, and Meropenem and high sensitivity (> 86%) to Imipenem, Norfloxacin, and Ciprofloxacin. There was high resistance to Amoxicillin, Ampicillin, Amikacin, Gentamicin, Cephalotin, Cefotaxime, Ceftriaxone, Ceftizoxime, Cephalexin, and Clindamycin. Gram-positive bacteria showed full sensitivity (100%) to Doxycycline, Piperacillin, and Tobramycin and reasonable sensitivity (> 75%) to Vancomycin, imipenem, and tetracycline. Azithromycin, Ampicillin, Gentamicin, Cefepime, Meropenem, Penicillin, Erythromycin, Oxacillin, and Amoxicillin showed resistance in 100% of cases. Conclusions: This study demonstrated high-sensitivity drugs for definitive treatment of neonatal sepsis (i.e., Vancomycin, Piperacillin, Tazobactam, and Meropenem for gram-negatives, and Piperacillin, and Tobramycin for gram-positive microorganisms).


e-CliniC ◽  
2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Tesalonika Kereh ◽  
Rocky Wilar ◽  
Suryadi N. N. Tatura

Abstract: Neonatal sepsis is defined as a clinical syndrome with systemic manifestations and bacteremia that occurs in the first month of life. Admnistration of antibiotics had to follow the pattern of the most common causal germs in a hospital. This study was aimed to determine the antibiotics of neonatal sepsis patients at the Neonatal Intensive Care Unit (NICU) of Prof. Dr. R. D. Kandou Hospital Manado, in this case types of antibiotics, duration of the used antibiotics, as well as the use of the first, second, and third-line antibiotics. This was a descriptive analytical study with a cross sectional design. Samples were neonatal sepsis patients who were treated with first, second, and third line antibiotic therapy at the NICU from September to November 2019. The results obtained a total of 40 patients, consisting of 22 males (55%) and 18 females (45%). The condition of the patients when coming out of the ward were 12 recovered (30%) and 28 died (70%). Combination antibiotics were the most common used as many as 37 cases (58%). The length of time using antibiotics based on lines, obtained that the first-line antibiotics were given at a duration of ≤5 days, while the second and third line antibiotics were more often given at a duration of >5 days. In conclusion, most neonatal sepsis patients were given antibiotics in combination. There were differences among the durations of the first, second and third line antibiotics used in patients with neonatal sepsis.Keywords: neonatal sepsis, antibiotics Abstrak: Sepsis neonatorum didefinisikan sebagai sindrom klinis dengan manifestasi sistemik dan bakterimia yang terjadi pada satu bulan pertama kehidupan. Pemberian antibiotik harus memperhatikan pola kuman penyebab tersering yang ada di suatu rumah sakit. Penelitian ini bertujuan untuk mengetahui penggunaan antibiotik pada pasien sepsis neonatorum di Neonatal Intensive Care Unit (NICU) RSUP Prof. Dr. R. D. Kandou Manado dalam hal ini jenis-jenis antibiotik yang digunakan, durasi penggunaan antibiotik yang diberikan, serta penggunaan antibiotik lini pertama, kedua, dan ketiga. Jenis penelitian ialah deskriptif analitik dengan desain potong lintang. Sampel penelitian ialah pasien sepsis neonatorum yang menggunakan terapi antibiotik lini pertama, kedua, dan ketiga yang dirawat di ruangan NICU periode September - November 2019. Hasil penelitian memperoleh total 40 pasien, terdiri dari 22 bayi laki-laki (55%) dan 18 bayi perempuan (45%). Keadaan pasien saat keluar dari ruang rawat 12 sembuh (30%) dan 28 meninggal (70%). Penggunaan antibiotik kombinasi paling banyak digunakan yaitu sebanyak 37 kasus (58%). Lama waktu penggunaan antibiotik berdasarkan lini, didapatkan antibiotik lini pertama paling banyak diberikan pada durasi ≤5 hari, sedangkan lini kedua dan ketiga lebih sering diberikan pada durasi >5 hari. Simpulan penelitian ini ialah sebagian besar pasien sepsis neonatorum diberikan antibiotik secara kombinasi. Terdapat perbedaan pada lama waktu penggunaan antibiotik pasien sepsis neonatorum baik lini pertama, kedua dan ketiga.Kata kunci: sepsis neonatorum, antibiotik


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