Diagnostics for neonatal sepsis: current approaches and future directions

Abstract

Progress has been made in the reduction of morbidity and mortality from neonatal sepsis. However, diagnosis continues to rely primarily on conventional microbiologic techniques, which can be inaccurate. The objective of this review is to provide the clinician with an overview of the current information available on diagnosing this condition. We review currently available diagnostic approaches for documenting neonatal sepsis and also describe novel approaches for diagnosing infection in neonates who are under development and investigation. Substantial progress has been made with molecular approaches and further development of non-culture-based methods offer promise. The potential ability to incorporate antimicrobial resistance gene testing in addition to pathogen identification may provide a venue to incorporate a predominantly molecular platform into a larger program of neonatal care.

Assessment and comparison of bacterial load levels determined by quantitative amplifications in blood culture-positive and negative neonatal sepsis

“…When neonates are critically ill, physicians usually prioritize life support exams, such as blood gases and electrolytes, to the detriment of other exams, so that the volume of blood placed into culture bottles is the remaining amount, which is frequently insufficient and more prone to contamination due to excessive handling. Inadequate blood volumes inserted into culture bottles are the main cause of blood cultures negativity 4 , 9 , 36 . In the present study, it is possible to guarantee that at least 1 mL of blood was used to perform blood cultures so that other causes have to be raised to explain why blood cultures fail to identify neonatal sepsis in cases with bacterial load levels above 1-10 CFU/mL 4 , 6 , 7 , 9 , 36 , 37 .…”

Дифференцированный Подход К Диагностике Раннего Неонатального Сепсиса У Преждевременно Рожденных Детей

“…Діагностика раннього неонатального сепсису (РНС) є складним завданням через відсутність специ-Íåîíàòîëîã³ÿ / Neonatology ® фічної клінічної картини захворювання й недостатню діагностичну цінність існуючих лабораторних тестів [7,8]. Актуальним є пошук нових біомаркерів, що можуть мати клінічне значення для діагностики, прогнозування та ефективності проведеної терапії РНС у передчасно народжених дітей [9,10]. Згідно з даними сучасних світових досліджень, перспективним є визначення тригерного рецептора, що експресується на мієлоїдних клітинах, -TREM-1 [11].…”

The Problem of Microbial Dark Matter in Neonatal Sepsis

“…( 19 ), and parasites such as Plasmodium , the agent responsible for malaria ( 20 ). Finally, any antimicrobial treatment administered before blood is collected further reduces the chances of recovering pathogens using culturing techniques ( 15 ).…”