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Objective: The aim of this study was to detect the rate of catheter-related bloodstream infection [CRBSI] in NICU of Mansoura University Children's Hospital and to focus on possible predictors of infection. Study
Design: A cross sectional comparative study to detect rate of CRBSI among neonates with central vascular catheters during the period between January 2009 and April 2012. Then, a nested case control study done among CRBSI cases and central vascular catheters none infected as a control group to detect predictors associated with their occurrence
Patients and Methods: Blood samples were collected from III neonates clinically suspected ofsepticemia and had inserted venous line. Central, peripheral blood and catheter tip cultures were done for each case
Results: CRBSI was confirmed in 69 cases as central blood culture count was > 3 folds of peripheral blood culture count. Catheter tip culture showed > 103 CFV/ ml per catheter of the same organisms. Low birth weight, age below 7 days, prematurity, mechanical ventilation, TPN administration and prolonged hospital stay were predictors of CRBSI. Logistic regression of the studied predictors showed that birth weight, TPN administration and length of central venous catheter stay were significant predictors of CRBSI
Conclusion: CRBSI is a common problem in NICU. Predictors of CRBSI included low birth weight, prematurity and mechanical ventilation. Potential use of TPN, prolonged catheter stay and low birth weight are independent predictors for CRBSI
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Introduction: Early onset bacterial sepsis is a feared complication of the newborn. A large proportion of infants admitted to the neonatal intensive care unit [NICU] for suspected sepsis receive treatment with potent systemic antibiotics while a diagnostic workup is in progress. The gold standard for detecting bacterial sepsis is blood culture. However, the sensitivity of blood culture is suspected to be low. Therefore, the diagnosis of sepsis is often based on the development of clinical signs, in combination with laboratory tests. Immunological assays of CD11b expression on peripheral blood neutrophil and serum E-selectin and molecular assays for the detection of bacterial DNA in the blood represent possible new diagnostic tools for early and rapid diagnosis of neonatal sepsis
Aim: This study aimed at comparing the valuability of bacteriological diagnosis of neonatal sepsis by blood culture technique and indirect methods of diagnosis
Methods: Bacteriological diagnosis of neonatal sepsis by blood culture technique and comparing it to indirect methods of diagnosis by assaying of neutrophil CD11b expression level by flowcytometry, estimation of elevated concentrations of serum E-selectin by enzyme linked immunosorbant assay and detection of bacterial DNA in blood samples by broad range PCR
Results: The infected group represented 60%. Klebsiella pneumoniae were the commonest isolated organisms in culture positive cases. CD11b expression assay by flowcytometry in infected and non infected cases showed a sensitivity of 77.8%, specificity of 100%, a PPV of 100% and a NPV of 75.1%. Serum E-selectin assay by ELISA in infected and non infected cases showed a sensitivity of 57.8%, specificity of 83.3%, a PPV of 83.8% and a NPV of 56.8%. PCR results had 88.5% sensitivity, 89.5% specificity, a PPV of 92% and a NPV of 85%
Conclusion: There is a need for CD11b expression assay, serum E-selectin level estimation and PCR as methods to quickly point out the infants with sepsis so such methods can be used as a supplement to traditional blood culture in diagnosis of neonatal sepsis and provide better diagnostic values as regarding rapidity of obtaining results and higher sensitivities and specificities, besides combination of multiple methods may provide more ease and accuracy for diagnosis
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Background and objectives: Accurate identification of neonatal sepsis is an increasing problem facing neonatologists due to non specific clinical signs with no existing single reliable marker of infection. Molecular assays for the detection of bacterial DNA in the blood represent possible diagnostic tools for early identification of bacterial causes. Procalcitonin [PCT] is a promising marker distinguishing between infection and inflammation which cannot be differentiated by acute phase proteins as C-reactive protein [CRP]. The aim of the study was to compare results of blood cultures with eubacterial PCR, PCT and CRP as early markers of neonatal sepsis
Subjects and methods: In this study, neonates with clinically suspected sepsis admitted to neonatal intensive care unit [NICU] in Mansoura University Children Hospital were included. Based on blood culture positive results, they were divided into 2 groups: proven sepsis and clinical sepsis. Comparing the 2 groups, sensitivity and specificity for, PCR, PCT and CRP were evaluated. Using receiver operating characteristic [ROC] curves, threshold value for both PCT and CRP were estimated
Results: Out of 141 neonates with clinically suspected sepsis, 56 (39.7%) were confirmed as proven sepsis. Compared to blood culture, the diagnosis of bacterial proven sepsis by PCR revealed 100 % sensitivity and 93% specificity. This study revealed that PCT >6.5 ng/ml had 83.9% sensitivity and 98.8% specificity, whereas CRP >3.5 mg/dl had 83.9%, sensitivity and 8l.2%specificity for diagnosing sepsis
Conclusion: This study confirms the value of PCR and PCT as rapid diagnostic tools for early detection of neonatal sepsis?
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Background: Acute respiratory tract infections [ARTI] are an important cause of childhood morbidity and mortality worldwide. Human metapneumovirus [hMPV] is now recognized as a major cause of ARTI in children. Objective: The objective "was to describe the clinical role and clinical features of hMPV in infants and young children hospitalized due to ARTI in Mansoura University Children's Hospital [MUCH]. Methods: Infants and children younger than 36 months old, admitted to MUCH with symptoms and signs of ARTI from December 20 JO to May 2011, were prospectively enrolled. Nasal wash aspirate specimens were collected for virus culture and for RT-PCR. The clinical features as well as radiological findings were recorded and analyzed. Results: A total of 54 infants and children with mean age 12.28 +/- 9.81 months were enrolled. There were 30 [55.56%] males and 24 [44.44%] females. HMPV was detected in 12 [22.22%] of the 54 patients studied by RT-PCR and only 3 of them were detected in viral culture. All patients with hMPV were less than 12 months of age. Nine [75%] of the hMPV positive cases were diagnosed as acute bronchiolitis and the remaining 3 [25%]) as pneumonia. Oxygen therapy was needed in 66.7% [n=36] of patients. Chest X-ray was abnormal in 77.78% [n=42] of patients. As regards seasonal distribution of hMPV, 66.66% of cases [8 patients] were observed in spring months while the remaining 4 hMPV positive cases [33.34%] were observed in winter months. None of patients included required ventilatory support or admission to intensive care unit. All patients achieved full recoveiy without j one-term sequelae after a mean duration of hospitalization of 5.56 +/- 0.78 days. Conclusions: HMPV is an important cuase of ARTI /;-; infants and young children. PCR is a rapid, sensitive and accurate method for diagnosis when compared to virus isolation by cell culture?
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Background and objectives: acinetobacter baumannii [A. baumannii] septicemia is an important cause of morbidity and mortality in neonates hospitalized in neonatal intensive care units [NICUs]. The difficulty of treating A. baumannii nosocomial infection is associated with the high resistance to a wide range of antimicrobial agents. We aimed to find the role of A. baumannii as a nosocomial pathogen causing neonatal septicemia with special concern on risk factors for their acquisition and metallobetalactamases [MBLs] production, aiming to implement infection control program and treat infections
Material and Methods: this study was conducted over 22 month period and included 272 neonates with suspected septicemia admitted to NICU, Mansoura University Children's Hospital. Blood samples were cultured from all cases. A. baumannii identification, susceptibility testing and MBL production using double-disc synergy test [DDST] and combined-disc test [CDT] were performed. Multiplex polymerase chain reaction [PCR] assay was done to detect and differentiate the five families of acquired MBL genes IMP, VIM, SPM, GIM and SIM in a single reaction
Results: A. baumannii was detected in 23/272 [8.45%]. Associated risk factors included low birth weight, the use of central venous catheters, mechanical ventilation and prior antibiotics use. Case fatality rate was 6/23[26.1%]. Resistance to imipenem was 8/23 [34.78%]. Resistance to other antimicrobials was 7[30.4%] meropenem, 12[52.17%] piperacillintazobactam, 11[47.8%] tobramycin, 18[78.26%] ceftazidime and 13[56.52%] ciprofloxacin. Of 8 imipenem-resistant isolated clinical strains 3[37.5%] and 2 [25%] were positive for MBL production by DDST and CDT respectively. PCR analysis revealed the presence of blaVIM gene in 1 [12.5%] isolate and blaIMP gene in 3 [37.5%] isolates. No imipenem-resistant A. baumannii isolates that harbored bla SPM, SIM or bla GIM were detected. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for DDST were 75% , 100% , 88% , 100% and 80% respectively and for CDT, they were 50% , 100% , 75% , 100% and 66.7% respectively. Interestingly, 1 [6.7%] imipenem sensitive isolate was positive MBL producer as harboring blaIMP gene by PCR
Conclusion: MBL producing A. baumannii prevalence is considerable and alarming in NICU and is associated with significant infant fatality. We recommend the consistent and constant surveillance of such strains for the amendment of empirical antimicrobial therapy and probably the reduction of mortality rates for neonates infected with MBL- producing isolates and avoiding the intra-hospital dissemination of such strains
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Background: The inflammatory cascade in sepsis is characterised by co-ordinated expression of proinflammatory cytokines as Tumour Necrosis Factor-alpha [TNF-alpha] and chemokines RANTES [Regulated upon Activation, Normal Tcell Expressed and Secreted], which are essential for host defence against microbial infection. This cascade and the use of newly discovered inflammatory mediators are focused upon for diagnosis of neonatal sepsis and outcome prediction
Objective: The aim of this study was to measure serum levels of TNF-alpha and RANTES in neonatal sepsis as diagnostic markers and to determine whether early and late onset neonatal sepsis were associated with differences in their concentrations
Study Design: Fifteen preterm and term infants showing clinical signs suggestive of an early-onset, or lateonset infection were studied. TNF-alpha and RANTES were determined in the serum at the first suspicion of sepsis and prior to commencement of antibiotic therapy. Fifteen healthy neonates were included as control group
Results: Serum TNF-alpha, WBC count and CRP concentrations were significantly higher in septic than non septic neonates. On the other hand, RANTES levels were significantly lower in the septic group compared to the non septic one while platelets count didn't show any significant difference between the two groups. There was no significant difference in the RANTES or TNF-alpha levels between infants suffering from early-onset or late-onset sepsis. Premature neonates like term neonates, responded to infection with an increased production of TNF-alpha and a decreased production of RANTES but no statistical difference was detected between the RANTES and TNF-alpha levels measured in the serum of premature and term neonates. Correlation analysis revealed a significant negative correlation between serum levels of TNF-alpha and RANTES and a significant positive correlation between serum levels of CRP and TNF-alpha in septic neonates. No significant correlation existed between CRP and TNF-alpha or between either TNF-alpha or RANTES and gestational age
Conclusion: C-C chemokines, RANTES and TNF- alpha are of value as early markers in diagnosis of neonatal sepsis. In this study, TNF-alpha is found to be the best diagnostic test for detection of neonatal sepsis followed by CRP when evaluated at first suspicion of sepsis
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To study the growth hormone-insulin like growth factor-1 [GH- IGF-I] axis in children with IDDM who had fair to good metabolic control, 20 seven prepubertal and pubertal patients having HbA1c less than 10% were investigated in addition to 30 healthy nondiabetic subjects of matched age and sex served as a control group. All subjects were evaluated clinically with thorough anthropometric measurements. In conclusion, patients with IDDM with fair to good metabolic control showed normal growth parameters and normal GH-IGF-I axis with heightened GH release in response to stress