RESUMO
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