Comparative Study of Four Tests of Bacterial Infection in the Neonate

Guillois, B.; Donnou, Marie Dominique; Sizun, Jacques; Bendaoud, Boutahar; Youinou, Pierre

doi:10.1159/000244105

Cited by 8 publications

(4 citation statements)

References 8 publications

(14 reference statements)

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“…The values for sensitivity and specificity in the literature vary widely, since there are significant differences in definitions used to count total neutrophils and sub-fractions; with sensitivity varying from 17 to 100% and specificity from 31 to 100%. 7,[17][18][19] The elevated negative predictive value of the WBC has been considered a valuable attribute, allowing clinicians greater confidence when ruling out a suspicion of late neonatal sepsis. 20 found that, during episodes of late sepsis, using sequential samples increased sensitivity from 61.5 to 84.4%…”

Section: Discussionmentioning

confidence: 99%

Acurácia diagnóstica do leucograma, proteína C-reativa, interleucina-6 e fator de necrose tumoral-alfa na sepse neonatal tardia

Caldas¹,

Marba²,

Blotta³

et al. 2008

J. Pediatr. (Rio J.)

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Objective: To evaluate the diagnostic value for late neonatal sepsis of white blood cell count (WBC) and assays for C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α), in isolation and in conjunction. Methods:This was a diagnostic test validation study. Chemiluminescence was used to assay CRP, IL-6 and TNF-α at the time of clinical suspicion and again after 24 and 48 hours, whereas the WBC was performed only once, at the time of suspicion. Patients were classified into three groups based on clinical progress and culture results: confirmed sepsis (CS), probable sepsis (PS), and not infected (NI). Statistical analysis was performed using the Wilcoxon and chi-square tests and Friedman analysis of variance; cutoffs were defined by plotting receiver operator characteristic curves. Results:The total study sample comprised 82 children, 42 of whom were classed as CS, 16 as PS and 24 as NI. At all three test times, the medians for CRP and IL-6 were significantly more elevated in the CS and PS groups, while the medians for TNF-α were abnormal only in the CS group. The CRP test had elevated indices of diagnostic utility at all three test times, better accuracy than the WBC and similar accuracy to the first IL-6 and TNF-α assays. There was no statistical difference between the cytokines, nor between them and the WBC. Combining tests did not increase diagnostic power, with the exception of the combination of WBC with CRP2 and when the sequential CRP assays were combined. Conclusions:Both CRP and WBC were useful for the diagnosis of late neonatal sepsis and comparable with IL-6 and TNF-α. Accuracy increased when CRP and WBC were combined and when sequential CRP assay results were used.J Pediatr (Rio J). 2008;84(6):536-542: Neonate, sepsis, C-reactive protein, interleukin-6, tumor necrosis factor, cytokine, inflammatory mediators.

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Section: Discussionmentioning

confidence: 99%

Acurácia diagnóstica do leucograma, proteína C-reativa, interleucina-6 e fator de necrose tumoral-alfa na sepse neonatal tardia

Caldas¹,

Marba²,

Blotta³

et al. 2008

J. Pediatr. (Rio J.)

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“…Equally difficult is the exclusion of infection in infants with suspected sepsis, as continuation of broad-spectrum antibiotics for presumptive bacterial infection frequently leads to unnecessary treatment and also the possibility of emergence of multiresistant organisms. In the past decade, many investigators, including our own investigating team, have used various hematologic and biochemical markers, and cytokines such as immature/total neutrophil ratio (3,4), CRP (4 -8), procalcitonin (8 -10), TNF-␣ (5, 11), IL-1␤ (5), soluble IL-1ra (12), IL-2 receptor (13), IL-6 (5, 12), IL-8 (7,14), , and markers of complementactivation (16,17) as indicators for early or confirmation of diagnosis of neonatal infection. We have previously demonstrated that the combination of IL-6 and serial CRP measurements gave a reasonably high sensitivity and specificity for diagnosing late-onset nosocomial infection (5).…”

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confidence: 99%

Neutrophil CD64 Expression: A Sensitive Diagnostic Marker for Late-Onset Nosocomial Infection in Very Low Birthweight Infants

et al. 2002

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This study aims to evaluate the diagnostic utilities of four leukocyte surface antigens-two lymphocyte antigens (CD25 and CD45RO) and two neutrophil antigens (CD11b and CD64)-for identification of late-onset nosocomial bacterial infection in preterm, very low birthweight infants, and to define the optimal cutoff value for each marker so that it may act as a reference with which future studies can be compared. Very low birthweight infants in whom infection was suspected when they were Ͼ72 h of age were eligible for the study. A full sepsis screen was performed in each episode. IL-6, C-reactive protein, and leukocyte surface antigens (CD25, CD45RO, CD11b, and CD64) were measured at 0 (at the time of sepsis evaluation), 24, and 48 h by standard biochemical methods and quantitative flow cytometric analysis. The diagnostic utilities including sensitivity, specificity, and positive and negative predictive values of each marker and combination of markers for predicting late-onset neonatal infection were determined. One hundred twenty-seven episodes of suspected clinical sepsis were investigated in 80 infants. Thirty-seven episodes were proven infection. The calculated optimal cutoff values for CD25, CD45RO, CD11b, and CD64 were 3,100, 2,900, 10,450, and 4,000 phycoerythrinmolecules bound per cell, respectively. An interim analysis of data after 68 episodes suggested that CD25 and CD45RO were poor predictors of neonatal infection with sensitivity or specificity Ͻ75% during a single measurement. Thus, these two markers were excluded from further investigation. In the final analysis, CD64 has the highest sensitivity (95-97%) and negative predictive value (97-99%) at 0 and 24 h after the onset. The addition of IL-6 or C-reactive protein (0 h) to CD64 (24 h) further enhanced the sensitivity and negative predictive value to 100%, and has the specificity and positive predictive value exceeding 88% and 80%, respectively. Neutrophil CD64 expression is a very sensitive marker for diagnosing late-onset nosocomial infection in very low birthweight infants. If further validated, the use of CD64 as an infection marker should allow early discontinuation of antibiotic treatment at 24 h without waiting for the definitive microbiologic culture results. The quantitative flow cytometric analysis applied in this study could be developed into a routine clinical test with high comparability and reproducibility across different laboratories. Vol. 51, No. 3, 2002 Copyright © 2002 Printed in U.S.A. ABSTRACT296

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“…In prematures, the volume of blood sent for culture may be lower than needed to detect the organism responsible for sepsis [16]. If the obligatory blood culture did not show growth, additional laboratory and clinical signs [17] predictive for infection [8][9][10][11] were required for "clinical sepsis." Fifty-four percent of NIs in our VLBW infants were such episodes, but only one third were culture proven.…”

Section: Discussionmentioning

confidence: 99%

“…2) CONS are isolated from blood culture/intravascular access device AND the neonate has any of the following: fever/hypothermia, apnea/bradycardia, tachycardia, time of recapillarisation > 2 s or otherwise unexplained metabolic acidosis AND at least one of the following laboratory signs: (C-reactive-protein CRP) > 2.0 mg/dl, immature/total neutrophil ratio > 0.2, leukocytopenia < 5,000/µl or thrombocytopenia < 100,000/µl. For "clinical sepsis," no organism is detected in blood culture but one of the following is present: fever/ hypothermia, apnea/bradycardia, tachycardia, time of recapillarization > 2 s or otherwise unexplained metabolic acidosis AND physician institutes appropriate antimicrobial therapy for sepsis [8][9][10][11]. "Radiographic pneumonia": radiologic examination of chest shows infiltrate, opacification, fluid in lobar fissures/pleura AND any of the following: purulent tracheal secretions, organism isolated from blood culture, isolation of pathogen in respiratory secretions, detection of pathogen antigen in respiratory secretions, CRP > 2.0 mg/dl, or immature/total neutrophil ratio > 0.2.…”

Section: Cultures Antibiotics and Surveillancementioning

confidence: 99%

Neonatal Nosocomial Infection Surveillance: Incidences by Site and a Cluster of Necrotizing Enterocolitis

Hentschel¹,

Veer

Gastmeier

et al. 1999

Infection

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Nosocomial infection (NI) was prospectively studied in hospitalized neonates during a 10-month period. The Centers for Disease Control (CDC) criteria (some specified for neonates) were used for surveillance. Forty-nine of 677 infants experienced 73 episodes of NI. The overall incidence was 10.8 NI/100 patients and 6.5 NI/1,000 patient days. The average monthly NI number did not correlate with patient load. Very low birth weight (VLBW) infants showed a higher NI incidence (81.8 NI/100 patients and 11.1 NI/1,000 patient days), also elevated if adjusted for their inherently longer neonatal intensive care unit (NICU) stay. The most common NI sites in the VLBW stratum were sepsis and necrotizing enterocolitis (NEC), the latter occurring in a seasonal cluster. It can be concluded that surveillance for NIs should focus on VLBW infants and include the evaluation of NEC, as it behaves like a nosocomial disease.

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Comparative Study of Four Tests of Bacterial Infection in the Neonate

Cited by 8 publications

References 8 publications

Acurácia diagnóstica do leucograma, proteína C-reativa, interleucina-6 e fator de necrose tumoral-alfa na sepse neonatal tardia

Acurácia diagnóstica do leucograma, proteína C-reativa, interleucina-6 e fator de necrose tumoral-alfa na sepse neonatal tardia

Neutrophil CD64 Expression: A Sensitive Diagnostic Marker for Late-Onset Nosocomial Infection in Very Low Birthweight Infants

Neonatal Nosocomial Infection Surveillance: Incidences by Site and a Cluster of Necrotizing Enterocolitis

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