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Objectives:To study the clinical significance of time to positive (TTP) of blood culture for neonatal sepsis.Methods:From August 2016 to June 2019, a retrospective study was conducted in patients with positive blood cultures admitted to the Neonatology Department of our hospital. The patients were assigned into different groups according to the species of pathogen, types of neonatal sepsis and the samples contaminated or not. TTP of different groups were analyzed.Results:A total of 307 cases with positive blood cultures were identified from 10 035 cases with blood culture specimens. Among the 307 cases, 162 were contaminated (the contaminated group) and 145 (1.4%) were diagnosed of neonatal sepsis (the pathogenic group). The proportion of TTP <24 h, 24~<48 h, 48~<72 h and ≥72 h in the 145 sepsis cases were 90.3% (131/145), 7.6% (11/145), 1.4% (2/145) and 0.7% (1/145), respectively. The median TTP was 9.0 h in early-onset sepsis (EOS) group and 11.5 h in late-onset sepsis (LOS) group. The median TTP of the contaminated group was 24.5 (19.9, 30.5)h, which was longer than 11.1 (8.1,16.2)h of the pathogenic group ( P<0.05). The median TTP of Gram (+) group was 14.0 (9.4,18.8)h, which was longer than 9.6 (7.5,11.3)h of Gram (-) group ( P<0.05). The median TTP of fungi group was 32.5 (25.5, 39.0) h, which was longer than 10.6 (8.1, 15.5)h of bacteria group ( P<0.05). Conclusions:Different pathogens has different TTP for neonatal sepsis. If blood culture maintains negative for more than 72 h, empiric use of antibiotics may be discontinued for patients of suspected sepsis without specific clinical manifestations or other lab results.
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Objective To analyze the clinical features,etiology and outcome of neonatal sepsis,and to clarify the characteristics of early-onset sepsis and late-onset sepsis,which may provide clinical evidence for early diagnosis and treatment of neonatal sepsis.Methods Two hundred and twenty-nine cases of neonatal sepsis who were hospitalized in the First Neonatal Wards,Shengjing Hospital Affiliated to China Medical University First Neonatal Wards from June 2013 to June 2016,and according to the onset time,they were divided into the early-onset sepsis (EOS) group and the late-onset sepsis(LOS) group,and SPSS 20.0 statistical software was used for comparative analysis of the data concerning the general situation,clinical manifestation,laboratory examination,pathogen distribution,complications and outcome between 2 groups,and Logistic stepwise regression was used to detect multiple factors.Results Sixty-eight patients (29.69％) were in the EOS group,and among them the full-term infants with normal weight accounted for 51.5％;161 cases (70.31％) were in the LOS group with extremely low birth weight premature infants occupying 52.2％.The mothers with gestational hypertension,after the birth of mechanical ventilation,parenteral nutrition (＞3 d),indwelling peripherally inserted central catheters (＞ 5 d) had significant correlations with sepsis (all P ＜0.05).They had fever and jaundice,complicated with purulent meningitis in the EOS group.The apnea and abdominal distension seemed more easily complicated with necrotizing enterocolitis in the LOS group.There as no difference in laboratory test indexes such as platelet,C-reactive protein (CRP) (all P ＞ 0.05).Procalcitonin and CRP had higher sensitivity in the diagnosis of sepsis.EOS was given priority to Gram-positive bacteria,which was far more common coagulase negative staphylococcus [26.5％ (18/68 cases)],and LOS was due to mainly Gram-negative bacteria and the main pathogens were klebsiella pneumoniae in 86 cases (53.4％).The mortality in the EOS group was significantly higher than that in the LOS group[7.4％ (5/68 cases) vs.2.5％ (4/161 cases)],but the difference was not statistically significant (x2 =4.72,P ＞ 0.05).Conclusions Because time of neonatal sepsis onset time is different,the clinical characteristics,the distribution of etiology and outcome also show some differences,and full-terms often have EOS which is more common in the premature babies with LOS.There are various high risk factors for sepsis in perinatal and postnatal period.Therefore,early and timely diagnosing the neonatal sepsis has great significance in reducing the mortality of neonatal sepsis.
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Objective@#To analyze the clinical features, etiology and outcome of neonatal sepsis, and to clarify the characteristics of early-onset sepsis and late-onset sepsis, which may provide clinical evidence for early diagnosis and treatment of neonatal sepsis.@*Methods@#Two hundred and twenty-nine cases of neonatal sepsis who were hospita-lized in the First Neonatal Wards, Shengjing Hospital Affiliated to China Medical University First Neonatal Wards from June 2013 to June 2016, and according to the onset time, they were divided into the early-onset sepsis (EOS) group and the late-onset sepsis(LOS) group, and SPSS 20.0 statistical software was used for comparative analysis of the data concerning the general situation, clinical manifestation, laboratory examination, pathogen distribution, complications and outcome between 2 groups, and Logistic stepwise regression was used to detect multiple factors.@*Results@#Sixty-eight patients (29.69%) were in the EOS group, and among them the full-term infants with normal weight accounted for 51.5%; 161 cases (70.31%) were in the LOS group with extremely low birth weight premature infants occupying 52.2%.The mothers with gestational hypertension, after the birth of mechanical ventilation, parenteral nutrition(>3 d), indwelling peripherally inserted central catheters (>5 d) had significant correlations with sepsis(all P<0.05). They had fever and jaundice, complicated with purulent meningitis in the EOS group.The apnea and abdominal distension seemed more easily complicated with necrotizing enterocolitis in the LOS group.There as no difference in laboratory test indexes such as platelet, C-reactive protein (CRP) (all P>0.05). Procalcitonin and CRP had higher sensitivity in the diagnosis of sepsis.EOS was given priority to Gram-positive bacteria, which was far more common coagulase negative staphylococcus [26.5%(18/68 cases)], and LOS was due to mainly Gram-negative bacteria and the main pathogens were klebsiella pneumoniae in 86 cases (53.4%). The mortality in the EOS group was significantly higher than that in the LOS group[7.4%(5/68 cases) vs.2.5%(4/161 cases)], but the difference was not statistically significant (χ2=4.72, P>0.05).@*Conclusions@#Because time of neonatal sepsis onset time is different, the clinical characteristics, the distribution of etiology and outcome also show some differences, and full-terms often have EOS which is more common in the premature babies with LOS.There are various high risk factors for sepsis in perinatal and postnatal period.Therefore, early and timely diagnosing the neonatal sepsis has great significance in reducing the mortality of neonatal sepsis.
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Objective To investigate the clinical value of C-reactive protein (CRP) combined with prothrombin time (PT) and partially activated thromboplastin time (APTY) in the diagnosis of neonatal late-onset sepsis.Methods From January 2013 to January 2018,100 neonates with sepsis admitted to our department of neonatology in Lishui Maternal and Child Health-Care Center were collected.According to the results of blood culture,neonates with positive blood culture were classified as sepsis group A (53 cases),and neonates with negative blood culture were classified as sepsis group B (47 cases).Another 50 normal newborns born at the same period were included in the control group.The CRP,PT and APTT values of the three groups were detected and compared.The receiver-operating characteristic curves (ROC) were plotted to obtain the area under ROC curve (AUC) and the sensitivity,specificity,positive predictive value and negative predictive value.Another ROC curve was plotted to obtain the area under ROC curve (AUC) and the sensitivity,specificity,positive predictive value,and negative predictive value for a new variable,CPR + PT + APTT,which was established using a binomial logistic regression method.Results The results of CPR,PT and APTT in the control group,sepsis group A and sepsis group B all increased in turn (F=10.616,6.155,5.243,P =0.000,0.000,0.000).CPR + PT + APTT had the largest AUC (0.94),the highest sensitivity (93.42％),the highest specificity (91.66％),the highest positive predictive value (92.60％),and the highest negative predictive value (78.55％) in the four indicators.Conclusion When blood culture fails to diagnose late-onset neonatal sepsis,combined detection of CPR + PT + APTT can provide some clues for its early diagnosis,which is worthy of clinical attention.