Comparison of 16S rRNA gene PCR and blood culture for diagnosis of neonatal sepsis

被引:36
作者
Liu, C. L. [1 ]
Ai, H. W. [2 ]
Wang, W. P. [3 ]
Chen, L. [1 ]
Hu, H. B. [2 ]
Ye, T. [3 ]
Zhu, X. H. [1 ]
Wang, F. [1 ]
Liao, Y. L. [1 ]
Wang, Y. [1 ]
Ou, G. [1 ]
Xu, L. [1 ]
Sun, M. [1 ]
Jian, C. [1 ]
Chen, Z. J. [1 ]
Li, L. [1 ]
Zhang, B. [1 ]
Tian, L. [1 ]
Wang, B. [1 ]
Yan, S. [1 ]
Sun, Z. Y. [1 ]
机构
[1] Huazhong Univ Sci & Technol, Tongji Hosp, Dept Clin Lab, Tongji Med Coll, Wuhan 430030, Peoples R China
[2] Childrens Hosp, Dept Clin Lab, Wuhan 430030, Peoples R China
[3] Women & Children Hosp, Dept Clin Lab, Wuhan 430030, Peoples R China
来源
ARCHIVES DE PEDIATRIE | 2014年 / 21卷 / 02期
关键词
POLYMERASE-CHAIN-REACTION;
D O I
10.1016/j.arcped.2013.11.015
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Septicemia is a common cause of morbidity and mortality among newborns in the developing world. However, accurate clinical diagnosis of neonatal sepsis is often difficult because symptoms and signs are often nonspecific. Blood culture has been the gold standard for confirmation of the diagnosis. However, the sensitivity is low and results are usually not promptly obtained. Therefore, the diagnosis of sepsis is often based on clinical signs in association with laboratory tests such as platelets count, immature/total neutrophils ratio (I/T), and a rise in C-reactive protein (CRP). Polymerase chain reaction (PCR) methods for the detection of neonatal sepsis represent new diagnostic tools for the early identification of pathogens. Methods. During a 4-month prospective study, 16S rRNA PCR was compared with conventional blood culture for the diagnosis of neonatal bacterial sepsis. In addition, the relationship between known risk factors, clinical signs, laboratory parameters, and the diagnosis of sepsis was considered. Results. Sepsis was suspected in 706 infants from the intensive neonatal care unit. They all were included in the study. The number of positive cultures and positive PCR results were 95 (13.5%) and 123 (17.4%), respectively. Compared with blood culture, the diagnosis of bacterial sepsis by PCR revealed a 100.0% sensitivity, 95.4% specificity, 77.2% positive predictive value, and 100.0% negative predictive value. In this study, Apgar scores at 5 mm, weight, icterus, irritability, feeding difficulties, gestational age (GA), premature rupture of membrane (PRM), platelets count, LIT, and a marked rise in CRP were important in establishing the diagnosis of sepsis in the newborn. In addition, weight, GA, PRM, irritability, duration of antibiotic usage, mortality rate, and number of purulent meningitis cases were significantly different between early-onset sepsis and late-onset sepsis. Conclusion. 16S rRNA PCR increased the sensitivity in detecting bacterial DNA in newborns with signs of sepsis, allowed a rapid detection of the pathogens, and led to shorter antibiotic courses. However, uncertainty about the bacterial cause of sepsis was not reduced by this method. 16S rRNA PCR needs to be further developed and improved. Blood culture is currently irreplaceable, since pure isolates are essential for antimicrobial drug susceptibility testing. (C) 2013 Published by Elsevier Masson SAS.
引用
收藏
页码:162 / 169
页数:8
相关论文
共 24 条
[1]   Neonatal infections in China, Malaysia, Hong Kong and Thailand [J].
Al-Taiar, Abdullah ;
Hammoud, Majeda S. ;
Liu Cuiqing ;
Lee, Jimmy K. F. ;
Lui, Kin-Man ;
Nakwan, Narongsak ;
Isaacs, David .
ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, 2013, 98 (03) :F249-F255
[2]   Diagnostic tests in neonatal sepsis [J].
Arnon, Shmuel ;
Litmanovitz, Ita .
CURRENT OPINION IN INFECTIOUS DISEASES, 2008, 21 (03) :223-227
[3]   Late-onset neonatal infections: incidences and pathogens in the era of antenatal antibiotics [J].
Didier, Capucine ;
Streicher, Marie-Pierre ;
Chognot, Didier ;
Campagni, Raphaele ;
Schnebelen, Albert ;
Messer, Jean ;
Donato, Lionel ;
Langer, Bruno ;
Meyer, Nicolas ;
Astruc, Dominique ;
Kuhn, Pierre .
EUROPEAN JOURNAL OF PEDIATRICS, 2012, 171 (04) :681-687
[4]   New Approaches to Preventing, Diagnosing, and Treating Neonatal Sepsis [J].
Edmond, Karen ;
Zaidi, Anita .
PLOS MEDICINE, 2010, 7 (03) :1-8
[5]   CRP as a predictive of neonatal sepsis and its role in differentiating the aetiologies [J].
Erdeve, Omer ;
Celik, Istemi Han ;
Uras, Nurdan ;
Demirel, Fatma Gamze ;
Oguz, Serife Suna ;
Dilmen, Ugur .
ACTA PAEDIATRICA, 2011, 100 (02) :160-161
[6]   Epidemic Microclusters of Blood-Culture Proven Sepsis in Very-Low-Birth Weight Infants: Experience of the German Neonatal Network [J].
Haertel, Christoph ;
Faust, Kirstin ;
Avenarius, Stefan ;
Bohnhorst, Bettina ;
Emeis, Michael ;
Gebauer, Corinna ;
Groneck, Peter ;
Heitmann, Friedhelm ;
Hoehn, Thomas ;
Hubert, Mechthild ;
Kribs, Angela ;
Kuester, Helmut ;
Laux, Reinhard ;
Moegel, Michael ;
Mueller, Dirk ;
Olbertz, Dirk ;
Roll, Claudia ;
Siegel, Jens ;
Stein, Anja ;
Vochem, Matthias ;
Weller, Ursula ;
von der Wense, Axel ;
Wieg, Christian ;
Wintgens, Juergen ;
Hemmelmann, Claudia ;
Simon, Arne ;
Herting, Egbert ;
Goepel, Wolfgang .
PLOS ONE, 2012, 7 (06)
[7]   Comparison of 16S rRNA gene PCR and BACTEC 9240 for detection of neonatal bacteremia [J].
Jordan, JA ;
Durso, MB .
JOURNAL OF CLINICAL MICROBIOLOGY, 2000, 38 (07) :2574-2578
[8]   Evaluating the near-term infant for early onset sepsis - Progress and challenges to consider with 16S rDNA polymerase chain reaction testing [J].
Jordan, Jeanne A. ;
Durso, Mary Beth ;
Butchko, Allyson R. ;
Jones, Judith G. ;
Brozanski, Beverly S. .
JOURNAL OF MOLECULAR DIAGNOSTICS, 2006, 8 (03) :357-363
[9]   AVOIDANCE OF FALSE POSITIVES [J].
KITCHIN, PA ;
SZOTYORI, Z ;
FROMHOLC, C ;
ALMOND, N .
NATURE, 1990, 344 (6263) :201-201
[10]   CURRENT ANTIBACTERIAL THERAPY FOR NEONATAL SEPSIS AND MENINGITIS [J].
KLEIN, JO .
PEDIATRIC INFECTIOUS DISEASE JOURNAL, 1990, 9 (10) :783-784