ABSTRACT
Objectives: Early and accurate treatment of an infant with suspected sepsis is the gold for his survival. Cytokines are important proinflammatory mediators in the early phases of the sepsis syndrome. Recent investigations have demonstrated that some antibiotics, in addition to their antimicrobial effects, can interfere with cytokine production. This study was designed to determine the level of serum TNF-alpha in late neonatal septicemia [LOS] before and after antibiotic therapy to assess its role as a marker of success or failure of such therapy
Methods: Forty preterm neonates with culture proven LOS who were admitted to NICU, Pediatric Department, Tanta University Hospital during the period from January 2009 to January 2010 in addition to ten healthy full term and ten healthy preterm control neonates and 36 cases received final diagnosis of non-sepsis were included in this case control study. Selected neonates were classified into four groups according to the results of antibiogram. Group I: received ampicillin and cefotaxime and were sensitive to one or both of them. Group II: received ampicillin and cefotaxime and were resistant to them. Group III: received ampicillin and amikacin and were sensitive to one or both of them. Group IV: received ampicillin and amikacin and were resistant to them. The causative micro-organisms and their antibiograms were microbiologically determined with estimation of serum TNF- alpha using ELISA technique before and 24 hours and 72 hours after start of antibiotic treatment
Results: Forty neonates with laboratory confirmed LOS were enrolled in this study. klebsiella [42.5%] and coagulase negative staphylococci [25%] constituted the majority of the isolated organisms. LOS cases had significantly high serum level of TNF-alpha than preterm and fullterm controls as well as no-sepsis group [P<0.0001]. Only in group I and III, there was significant increase [P<0.0001 and P= 0.0001, respectively] in the levels of TNF-alpha after 24 hours of treatment as compared to TNF-alpha level before treatment, and significant decrease [P<0.0001] in TNF-alpha level after 72 hours of treatment as compared to 24 hours level
Conclusion: TNF-alpha is a powerful early predictor of LOS. Measurement of serum TNF- alpha during empiric treatment of neonatal sepsis could be a powerful indicator of appropriateness of antibiotic therapy. Therefore, increase of TNF - alpha level during initial treatment especially during the first day of treatment of neonatal sepsis may be taken as indication for sensitivity to initial antibiotics, even before sensitivity of microbiological causes to given antibiotics is known