Pharmacologic Treatment of Neonatal Sepsis: Antimicrobial Agents and Immunotherapy

Cavaliere, Terri A.

doi:10.1111/j.1552-6909.1995.tb02547.x

Cited by 7 publications

(8 citation statements)

References 45 publications

(66 reference statements)

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“…Over several decades, reduced pFN levels have been associated with sepsis [21][22][23][24][25][26][27][28][29] to the extent that several authors have evaluated the effects of treatment with FN concentrates. [32][33][34] According to Stathakis et al, 21 sex and age are not associated with the concentration of pFN, thus the lack of parity between the septic and control subjects is not considered to affect the results discussed here. There are some situations, such as in cryofibrinogenaemia or intravascular disseminated coagulation, in which pFN can be abnormally low, possibly due to enhanced catabolism of the protein secondary to intravascular fibrin formation.…”

Section: Discussionmentioning

confidence: 64%

Plasma fibronectin as a marker of sepsis

Martín

Prieto

Cabo

et al. 2004

International Journal of Infectious Diseases

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Plasma FN appears to act as a marker of sepsis in that patients showed diminished pFN levels. Along with other clinical and laboratory variables, the use of this marker would allow a rapid diagnosis of sepsis and limit the number of blood cultures to be processed and the number of antibiotic prescriptions, particularly when symptoms are insidious and diagnosis is doubtful. We propose further and more complex studies using a higher number of patients.

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Section: Discussionmentioning

confidence: 64%

Plasma fibronectin as a marker of sepsis

Martín

Prieto

Cabo

et al. 2004

International Journal of Infectious Diseases

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“…2 Some of the reasons for this include intermittent seeding of low numbers of bacteria within the blood stream, the small volumes of blood obtained from infants for culture, and the increasingly common practice of providing intrapartum antibiotic prophylaxis to mothers of high-risk deliveries. [13][14][15] It is well known that the smaller the blood volume obtained for culture, the lower the chances of recovering organisms. 16,17 Although infants tend to have a somewhat greater magnitude of bacteremia compared with adults-10 to 300 CFU/ml versus 1 to 30 CFU/ml-the amount of blood sampled for culturing from neonates is significantly less than that taken from adults: Ͻ1 ml versus 10 to 30 ml.…”

mentioning

confidence: 99%

Real-Time Polymerase Chain Reaction for Detecting Bacterial DNA Directly from Blood of Neonates Being Evaluated for Sepsis

Jordan

Durso

2005

The Journal of Molecular Diagnostics

144

108

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Speed is of the essence when evaluating an infant with symptoms consistent with sepsis. Because of the high morbidity and mortality associated with neonatal sepsis, infants receive multiple, broad-spectrum antibiotics before receiving finalized blood culture results. Incorporating an additional, reliable, yet rapid assay to detect bacteria directly from blood would facilitate timely diagnosis and appropriate care. To this end, we designed a real-time polymerase chain reaction (PCR) assay targeting the highly conserved 380 bases of 16S rDNA. DNA was extracted from whole-blood samples using a Qiagen column. The limit of detection for the TaqMan-based assay, using a Smartcycler instrument, was 40, 50, or 2000 colony-forming units per milliliter of blood (CFU/ml) of Escherichia coli, group B Streptococcus, and Listeria monocytogenes, respectively, when white blood cell counts were below 39,000/ l. Implementing this approach requires less than 4 hours for both sample preparation and real-time PCR compared with 1 to 2 days to detect growth in culture or 5 days to finalize no-growth culture results. There was an overall agreement between the results of culture and real-time PCR of 94.1% (80 of 85) in this study. These results suggest that molecular techniques can augment culture-based methods for diagnosing neonatal sepsis, especially in infants whose mothers have received intrapartum antibiotic prophylaxis. (J Mol Diagn 2005, 7:575-581)

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“…2,12 In addition, maternal intrapartum antimicrobial prophylaxis and/or small blood volume collections from infants are cited as possible reasons for the lack of confidence in negative culture results. [13][14][15][16] At Magee-Women's Hospital, preliminary results are generated after 48 hours for blood cultures lacking detectable growth. However, final results for negative blood cultures are not finalized until after 5 days.…”

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confidence: 99%

Evaluating the Near-Term Infant for Early Onset Sepsis

Jordan

Durso

Butchko

et al. 2006

The Journal of Molecular Diagnostics

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Although the rate of early onset sepsis in the nearterm neonate is low (one to eight of 1000 cases), the rate of mortality and morbidity is high. As a result, infants receive multiple, broad-spectrum antibiotic therapy, many for up to 7 days despite blood cultures showing no growth. Maternal intrapartum antibiotic prophylaxis and small blood volume collections from infants are cited as reasons for the lack of confidence in negative culture results. Incorporating an additional, more rapid test could facilitate a more timely diagnosis in these infants. To this end, a 16S rDNA polymerase chain reaction (PCR) assay was compared to blood culturing for use as a tool in evaluating early onset sepsis. Of 1751 neonatal intensive care unit admissions that were screened, 1233 near-term infants met inclusion criteria. Compared to culture, PCR demonstrated excellent analytical specificity (1186 of 1216, 97.5%) and negative predictive value (1186 of 1196, 99.2%); however, PCR failed to detect a significant number of culture-proven cases. These findings underscore the cautionary stance that should be taken at this time when considering the use of a molecular amplification test for diagnosing neonatal sepsis. The experience gained from this study illustrates the need for changes in sample collection and preparation techniques so as to improve analytical sensitivity of the assay.

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Pharmacologic Treatment of Neonatal Sepsis: Antimicrobial Agents and Immunotherapy

Cited by 7 publications

References 45 publications

Plasma fibronectin as a marker of sepsis

Plasma fibronectin as a marker of sepsis

Real-Time Polymerase Chain Reaction for Detecting Bacterial DNA Directly from Blood of Neonates Being Evaluated for Sepsis

Evaluating the Near-Term Infant for Early Onset Sepsis

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