Comparative Study of Platelet count and C-Reactive Protein among Gram Positive, Gram Negative and Fungal Sepsis in Newborns

Abstract

Introduction: Septicemia is characterized by positive blood culture, thrombocytopenia & elevated C-reactive protein. Objective: To compare platelet indices and CRP among gram-positive, gram negative and fungal sepsis in newborns. Methods: This is a retrospective case analysis of 52 blood culture positive patients between January-2012 to December-2014. The parameters examined were Baseline Platelet Count, Change In Platelet Count, (Baseline Platelet count-Change in Platelet count)/ Baseline Platelet Count , Platelet nadir, incidence, duration & severity of Thrombocytopenia, baseline CRP, change in CRP, (baseline CRP-change in CRP)/ baseline CRP, CRP peak, incidence & duration of raised crp. Statistical analysis: All data were collected in validated preformatted proforma sheet & analysed using appropriate statistical methods. Results: Majority (61.53%) had gram negative sepsis. Klebsiella was the commonest organism & was isolated in 21.15% of babies. Weight of the baby (p= 0.014), CRP Peak (p= 0.034), incidence of high CRP (p = 0.003), duration of high CRP (p= 0.004) & duration of thrombocytopenia (p = 0.001) differed significantly among gram-positive, gram negative & fungal sepsis. Conclusion: We noted higher rise in CRP with prolonged duration following Gram negative sepsis. However the incidence of both raised CRP and thrombocytopenia were more among fungal sepsis. Though the onset was delayed, lower platelet nadir, more severe thrombocytopenia with prolonged duration was noted among fungal sepsis.

Frequency and Severity of Thrombocytopenia in Neonatal Sepsis

“…Similarly, while comparing hematological, infectious, and blood complete counts, it was discovered that in the case of C-reactive protein, the greater the CRP level, the lower the platelet level. This finding was also supported by Rabindran et al, in which they studied the CRP with platelet level in neonates and found out that the greater the CRP, the higher the thrombocytopenia [ 25 ]. Furthermore, the severity of gram-negative sepsis increased.…”

Comparative study of clinic-microbiological profile of fungal and bacterial sepsis in neonates

“…Rabindran et al also found that risk of fungal sepsis was significantly higher in lower birth weight babies as compared to bacterial sepsis (p value = 0.014). 10 In the present study, majority of the maternal factors were found insignificant like meconium stained liquor (MSL), per vaginal examinations >3 and maternal fever and mode of delivery. Similar result for mode of delivery was found by Ho Lim W et al, Chib R et al 12,9 There were some studies on risk factors for fungal sepsis which showed insignificance of mode of delivery like Chaurasia D et al and Yunus M et al 24,11 On the other hand, Swanson JR et al found caesarean section as a significant risk factor for Candidial sepsis (p value <0.0001).…”

“…Corroborating with the present findings, Rabindran et al found higher incidence of reactive CRP (p value = 0.003) in fungal sepsis as compared to bacterial sepsis. 10 Study by Ho Lim W et al also showed similar result (100% versus 83.5%, p value = 0.009). 12 In systemic fungal infections, CRP levels are high as compared to superficial fungal infections like acute fungal stomatitis.…”

“…25 In the present study, thrombocytopenia (platelet count <1.0 lac) occurred significantly more in fungal sepsis as compared to bacterial ones, 91.53% versus 51.51% (p value ≤0.001). Warris et al gave similar results (100% versus 50%), so did, Rabindran et al, Charoo et al, and Ho Lim W et al 25,10,26,12 While Manzoni P et al found no significant difference (19.6% versus 16.4%). 27 This study revealed that C-reactive protein (CRP) was reactive in 84.75% cases of fungal sepsis while it was reactive in only 59.04% cases of bacterial sepsis.…”

“…9 Also, Rabindran et al notes 88.47% bacterial cases and 11.53% fungal cases. 10 15,16,12,[17][18][19] Higher incidence of late onset sepsis in our study can be because of outborn admissions, longer hospital stays and increased invasive procedures and device usage.…”