Evaluation of procalcitonin as a diagnostic marker in neonatal sepsis

Context: Neonatal sepsis is an early infection occurring within 28 days of the postnatal life. It has nonspecific signs and symptoms which make the diagnosis cumbersome. It inflicts an increase in morbidity and mortality among neonates. Procalcitonin (PCT) is yet another acute phase reactant, which is synthesized by the C-cells of thyroid gland. Aims: The aim of our study is to evaluate PCT as a diagnostic marker of neonatal sepsis in comparison with C-reactive protein (CRP). Subjects and Methods: A prospective cross-sectional study was conducted at our tertiary care hospital in Puducherry. The study was conducted over a period of 5 months from November 2015 to 2016. The study included all neonates with clinical signs of sepsis. The neonates were assigned into three groups as proven sepsis, suspected sepsis, and no sepsis group. The CRP level and PCT level were compared between the three groups, and their sensitivity and specificity were calculated. Statistical Analysis Used: The mean, standard deviation, and standard error of mean were calculated. The groups were compared using one-way ANOVA. The diagnostic test efficiency was evaluated by receiver operating characteristic curve analysis. Results: A total of 75 neonates were included in our study. There were 9 (12%) neonates with proven clinical sepsis, 47 (62.6%) neonates with suspected clinical sepsis, and 19 (25.3%) neonates with no sepsis. The mean and standard error of mean were calculated for CRP and PCT in all the three groups. The results showed a sensitivity of 88.90% for both CRP and PCT and specificity of 89.40% for CRP and 80.30% for PCT. The common organisms isolated from culture-positive group were Escherichia coli (22.2%), Pseudomonas aeruginosa (22.2%), and Candida albicans (22.2%), followed by Klebsiella pneumoniae, Acinetobacter baumannii, and methicillin-resistant Staphylococcus aureus. Conclusions: PCT may not be sufficiently used as a sole marker of sepsis in neonates compared to CRP. PCT in conjunction with CRP and other tests for septic screen can aid in better diagnosis of neonatal sepsis.

Aeromonas hydrophila meningitis and fulminant sepsis in preterm newborn: A case report and review of literature.

Neonatal meningitis is a lethal infection occurring in the 1st month of life. The risk of developing permanent neurological sequels is high among the neonates who survive. Bacterial pathogens are commonly associated with this condition. Aeromonas is a Gram‑negative bacteria of aquatic habitat. Although isolation of Aeromonas species from neonates with blood stream infection is infrequently reported, neonatal meningitis caused by Aeromonas is exceedingly rare. We present a case of fulminant sepsis and meningitis caused by Aeromonas hydrophila in a preterm newborn male. The bacteria was isolated in culture from blood and cerebrospinal fluid. In spite of targeted antibiotics and supportive therapy, the baby failed to respond and died on the 12th day of life.

A cost-effective carbohydrate fermentation test for yeast using microtitre plate.

Carbohydrate fermentation test is a well-established technique for speciation of bacteria and fungi. However, long incubation period, cost and procedural complexity may limit its use. Here, we describe a simple modification of conventional carbohydrate fermentation technique using microtitre plate. Thirty-one yeast isolates were identified based on their fermentation property by microtitre plate method and results were compared with conventional method. The modified method had 85.7% sensitivity and 100% specificity. The average time taken to produce positive reaction was 24 hours. When compared with conventional method, modified method reduced turn-around time and cost of processing without significant increase in discordant results.