Can we improve early identification of neonatal late-onset sepsis? A validated prediction model

Goldberg, Ori; Amitai, Nofar; Chodick, Gabriel; Bromiker, Reuben; Scheuerman, Oded; Ben‐Zvi, Haim; Klinger, G

doi:10.1038/s41372-020-0649-6

Cited by 20 publications

(29 citation statements)

References 27 publications

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“…As is current practice in sepsis (Farkas, 2020;Goldberg et al, 2020), tuberculosis (Abakay et al, 2015), and reactive forms of leprosy (Gomes et al, 2020), biomarkers are being widely discussed and proposed as tests that complement the clinical decision making to predict the presence of severity in infections (Jager et al, 2012). Among the various parameters related to leukocytes in the bloodstream, the neutrophil/lymphocyte ratio (NLR) stands out for being a biomarker that is easily obtained and available in clinical practice, in addition to being significantly associated with systemic inflammation (Benites-Zapata et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

“…Similar to other infectious diseases like sepsis (Farkas, 2020;Goldberg et al, 2020), tuberculosis (Abakay et al, 2015), and reactive forms of leprosy (Gomes et al, 2020), biomarkers have been widely discussed and proposed as complementary tests to support a more assertive clinical decision. Similar to the importance of serum lactate in the management of sepsis, we aim to find a biomarker that can be easily obtained even in the most remote clinical laboratories in remote areas of Brazil and in other Latin American countries Currently, there are no laboratory biomarkers available to support clinical decision-making when differentiating between severe and non-severe patients with PCM, and that, consequently, culminates in the prescription of oral antifungal drugs orally for non-severe patients at the time of admission, or intravenous medication, associated with other hospital support care, for critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

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Puzzling paracoccidioidomycosis: Factors associated with the severity of Paracoccidioides lutzii infections

Nery

Camargo

Rodrigues

et al. 2021

International Journal of Infectious Diseases

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Puzzling paracoccidioidomycosis: Factors associated with the severity of Paracoccidioides lutzii infections

Nery

Camargo

Rodrigues

et al. 2021

International Journal of Infectious Diseases

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“…Disagreement between evaluating neonatologists was resolved by discussion or consulting a third neonatologist until consensus was achieved. The heath evaluation score ( Appendix 1 ) was graded into three groups as follows: healthy, equivocal, or sick appearing ( 11 ) and is similar to the classification of clinical signs used routinely to evaluate early-onset sepsis ( 12 , 13 ).…”

Section: Methodsmentioning

confidence: 99%

“…The study definitions have been previously described in detail ( 11 ). LOS was defined by a single positive blood culture by a causative pathogen 72 h or later after birth, with the exception of sepsis caused by coagulase negative staphylococci, which required two positive blood cultures.…”

Section: Methodsmentioning

confidence: 99%

Antibiotic Discontinuation 24 h After Neonatal Late-Onset Sepsis Work-Up—A Validated Decision Tree Model

et al. 2021

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Objectives: Neonatal late-onset sepsis work-up is a frequent occurrence in every neonatal department. Blood cultures are the diagnostic gold standard, however, a negative culture prior to 48–72 h is often considered insufficient to exclude sepsis. We aimed to develop a decision tree which would enable exclusion of late-onset sepsis within 24 h using clinical and laboratory variables.Study Design: Infants evaluated for late-onset sepsis during the years 2016–2019, without major malformations, in a tertiary neonatal center were eligible for inclusion. Blood cultures and clinical and laboratory data were extracted at 0 and 24 h after sepsis work-up. Infants with bacteriologically confirmed late-onset sepsis were compared to matched control infants. Univariate logistic regression identified potential risk factors. A decision tree based on Chi-square automatic interaction detection methodology was developed and validated.Results: The study cohort was divided to a development cohort (105 patients) and a validation cohort (60 patients). At 24 h after initial evaluation, the best variables to identify sepsis were C-reactive protein > 0.75 mg/dl, neutrophil-to-lymphocyte ratio > 1.5 and sick-appearance at 24 h. Use of these 3 variables together with blood culture status at 24 h, enabled identification of all infants that eventually developed sepsis through the decision tree model. Our decision tree has an area under the receiver operating characteristic curve of 0.94 (95% CI: 0.90–0.98).Conclusions: In non-sick appearing infants with a negative blood culture at 24 h and normal laboratory values, sepsis is highly unlikely and discontinuing antibiotics after 24 h is a viable option.

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“…[14][15][16] There have been also recent publications on its use in the neonatal population for its prognosticative value in the evaluation of neonatal sepsis. [17][18][19][20] However, studies on its use in the pediatric population in the evaluation of infection severity is very limited.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Diagnostic Value of Neutrophil-to-lymphocyte Count Ratio (NLR) and Platelet-to-lymphocyte Ratio (PLR) for Identifying Serious Infection (SI) and Serious Bacterial Infection (SBI) in Febrile Young Infants < 90 Days Old

Khoo

Ling

Yong-Kwang

2020

Preprint

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Background:Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are simple and easy to calculate biomarkers. They have been reported as a predictor of severity and prognosis in adult patients with bacteremia. However, there is a paucity of literature examining the use of NLR and PLR as a diagnostic biomarker in pediatrics. This study aims to evaluate the diagnostic value of the NLR and PLR for identifying serious infections (SI) and serious bacterial infections (SBI) in febrile young infants <90 days old. Methods: A retrospective review of neonates and infants who were admitted for evaluation of fever between 1st July 2018 and 31st December 2018 were reviewed retrospectively. Patients aged less than 90 days of life admitted for fever from the emergency department were included. Patient age, gender, comorbidities, body temperature, clinical findings and initial laboratory results including white blood cell (WBC) count, NLR, PLR, serum levels of C-Reactive Protein (CRP) were assessed, and the microbiological investigations and final clinical diagnoses were evaluated. Results: There were 561 patients identified for inclusion. SI and SBI were diagnosed in 166 (29.6%) and 98 (17.5%) patients. Mean absolute neutrophil count, NLR were significantly higher in the SI group compared to the non-SI group (1.39±1.04 vs 1.09±0.87, p=0.001). The NLR was also significantly different in the SBI compared to the non-SBI group (1.38±0.88 vs 1.13±0.94, p=0.019). PLR did not show statistical significance in differentiating SI or SBI from non SI or SBI group. For SI and SBI, the area under the Receiver Operating Characteristic (AUROC) curve value of NLR was 0.57 (95 % CI 0.46-0.69) and 0.61 (95% CI 0.48-0.73), respectively. Although we found significantly higher NLR values in infants with SI and SBI, our results indicate that CRP was more accurate at detecting SI and SBI. Conclusion: Our study provided initial evidence on the use of the NLR in combination with other biomarkers in the diagnosis of serious infection and serious bacterial infection in young infants < 90 days’ of life. Prospective evaluation of this finding is needed to assess further its clinical value in the evaluation of young febrile infants for SI and SBI.

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Can we improve early identification of neonatal late-onset sepsis? A validated prediction model

Cited by 20 publications

References 27 publications

Puzzling paracoccidioidomycosis: Factors associated with the severity of Paracoccidioides lutzii infections

Puzzling paracoccidioidomycosis: Factors associated with the severity of Paracoccidioides lutzii infections

Antibiotic Discontinuation 24 h After Neonatal Late-Onset Sepsis Work-Up—A Validated Decision Tree Model

Evaluation of the Diagnostic Value of Neutrophil-to-lymphocyte Count Ratio (NLR) and Platelet-to-lymphocyte Ratio (PLR) for Identifying Serious Infection (SI) and Serious Bacterial Infection (SBI) in Febrile Young Infants < 90 Days Old

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Can we improve early identification of neonatal late-onset sepsis? A validated prediction model

Cited by 20 publications

References 27 publications

Puzzling paracoccidioidomycosis: Factors associated with the severity of Paracoccidioides lutzii infections

Puzzling paracoccidioidomycosis: Factors associated with the severity of Paracoccidioides lutzii infections

Antibiotic Discontinuation 24 h After Neonatal Late-Onset Sepsis Work-Up—A Validated Decision Tree Model

Evaluation of the Diagnostic Value of Neutrophil-to-lymphocyte Count Ratio (NLR) and Platelet-to-lymphocyte Ratio (PLR) for Identifying Serious Infection (SI) and Serious Bacterial Infection (SBI) in Febrile Young Infants &lt; 90 Days Old

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Evaluation of the Diagnostic Value of Neutrophil-to-lymphocyte Count Ratio (NLR) and Platelet-to-lymphocyte Ratio (PLR) for Identifying Serious Infection (SI) and Serious Bacterial Infection (SBI) in Febrile Young Infants < 90 Days Old