Bacterial sepsis remains a major cause of mortality and blood cultures are the
gold standard of laboratory diagnosis even though they lack sensitivity in
neonates. Culturenegative sepsis, also known as clinical sepsis, has long been
considered a diagnosis in neonatal intensive care units because, as well as
culture-positive infants, culture-negative neonates have worse prognosis in
comparison with non-infected ones. Quantitative amplifications are used to
detect bacterial infections in neonates but results are considered only in a
qualitative way (positive or negative). The aim of the present study was to
determine and compare bacterial load levels in blood culture-positive and
culture-negative neonatal sepsis. Seventy neonates with clinical and laboratory
evidence of infection admitted at three neonatal intensive care units were
classified as blood culture-positive or culture-negative. Blood samples obtained
at the same time of blood cultures had bacterial load levels assessed through a
16S rDNA qPCR. Blood cultures were positive in 29 cases (41.4%) and qPCR in 64
(91.4%). In the 29 culture-positive cases, 100% were also positive by qPCR,
while in the 41 culture-negative cases, 35 (85.4%) were positive by qPCR.
Bacterial load levels were in general < 50 CFU/mL, but were significantly
higher in culture-positive cases (Mann-Whitney, p = 0.013), although clinical
and laboratory findings were similar, excepting for deaths. In conclusion, the
present study has shown that blood culture-negative neonates have lower bacteria
load levels in their bloodstream when compared to blood culture-positive
infants.
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