الفهرس 
Neonatal SepsisOnly 14 pages are availabe for public view
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Abstract
Neonatal sepsis is one of the major health problems throughout the world. Infections are a frequent and important cause of morbidity and mortality in the neonatal period. As many as 2% of fetuses are infected in utero and up to 10% of infants are infected in first month of life. Data suggests that among four main causes of neonatal death, infection topped the list. Every year an estimated 30 million newborns acquire infection and 1-2 million of these die.
The present study aimed to compare a broad range 16S rDNA PCR done on whole blood samples without prior enrichment to conventional blood culture for detecting bacterial DNA in blood samples from infants with suspected sepsis.
This study included 50 neonates with proven sepsis matched with clinical or laboratory findings suggestive of sepsis admitted at Neonatal Intensive Care Unit of Ain Shams University Hospitals during the period from May 2012 till August 2012. The age of neonates ranged from 1 to 50 days old. They were 28 males and 22 females. Fourteen of them were preterm and thirty-six were full terms.
A full history was taken including antenatal, natal, postnatal and history of antimicrobial therapy and its duration. Also, full clinical examination, routine laboratory investigations and microbiological testing of blood samples were done.
The study showed that 26 were diagnosed as early onset neonatal sepsis (EONS) versus 24 as late onset neonatal sepsis (LONS). Preterm neonates accounted for 28% with male to female ratio was 3:2.
The study also showed 30/50 (60%) gave positive blood culture result. The most frequently isolated microorganism was S.aureus (n=17, 56.66%), followed by Coagulase negative Staphylococci (n=7, 23.34%), E.coli (n=4, 13.34%), and Candida spp. (n=2, 6.67%).
S.aureus was the commonest organism isolated from neonates with early onset sepsis, followed by CONS while the least was E.coli. As regards late onset sepsis, S.aureus was also the commonest organism isolated followed by CONS, while the least were Candida spp.
As regards the relation between blood culture result and PCR result, 28 neonates gave positive bacterial blood culture with isolation of clinically significant microorganisms (after exclusion of cultures that yielded Candida spp.), while 35 neonates gave positive PCR results. However, 22 neonates gave a negative bacterial blood culture result and 15 neonates gave negative PCR results. Twenty neonates had positive bacterial blood culture/ PCR results, while 7 of neonates had negative bacterial blood culture/ PCR results. Eight neonates with a positive bacterial blood culture had a negative PCR result, 15 neonates had a positive PCR in spite of a negative bacterial blood culture. Considering the blood culture, the gold standard in diagnosis bacterial neonatal sepsis, the sensitivity, specificity, positive predictive value and negative predictive value of PCR in detecting bacteremia relative to blood cultures were 20/28 (71.42%), 8/22 (31.81%), 20/35 (57.14%) & 7/15 (46.66%) respectively.
The results also showed that fever was the most commonly found risk factor in relation to blood culture status and result of PCR, followed by premature rupture of membrane (PROM), followed by urinary tract infections, followed by vaginal infection, diabetes mellitus, difficult labour and multiple pregnancy then preterm labour and foul meconium.
There were statistically significant relations between blood culture status and some of risk factors as PROM, difficult labour and multiple pregnancies, while there is a statistically significant relation between PCR result and diabetes mellitus.