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World Health Organization Danger Signs to predict bacterial sepsis in young infants: A pragmatic cohort study

Bacterial sepsis is generally a major concern in ill infants. To help triaging decisions by front-line health workers in these situations, the World Health Organization (WHO) has developed danger signs (DS). The objective of this study was to evaluate the extent to which nine DS predict bacterial se...

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Autores principales: Akinseye, Omolabake, Popescu, Constantin R., Chiume-Kayuni, Msandeni, Irvine, Michael A., Lufesi, Norman, Mvalo, Tisungane, Kissoon, Niranjan, Wiens, Matthew O., Lavoie, Pascal M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10662722/
https://www.ncbi.nlm.nih.gov/pubmed/37988384
http://dx.doi.org/10.1371/journal.pgph.0001990
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author Akinseye, Omolabake
Popescu, Constantin R.
Chiume-Kayuni, Msandeni
Irvine, Michael A.
Lufesi, Norman
Mvalo, Tisungane
Kissoon, Niranjan
Wiens, Matthew O.
Lavoie, Pascal M.
author_facet Akinseye, Omolabake
Popescu, Constantin R.
Chiume-Kayuni, Msandeni
Irvine, Michael A.
Lufesi, Norman
Mvalo, Tisungane
Kissoon, Niranjan
Wiens, Matthew O.
Lavoie, Pascal M.
author_sort Akinseye, Omolabake
collection PubMed
description Bacterial sepsis is generally a major concern in ill infants. To help triaging decisions by front-line health workers in these situations, the World Health Organization (WHO) has developed danger signs (DS). The objective of this study was to evaluate the extent to which nine DS predict bacterial sepsis in young infants presenting with suspected sepsis in a low-income country setting. The study pragmatically evaluated nine DS in infants younger than 3 months with suspected sepsis in a regional hospital in Lilongwe, Malawi, between June 2018 and April 2020. Main outcomes were positive blood or cerebrospinal fluid (CSF) cultures for neonatal pathogens, and mortality. Among 401 infants (gestational age [mean ± SD]: 37.1±3.3 weeks, birth weight 2865±785 grams), 41 had positive blood or CSF cultures for a neonatal pathogen. In-hospital mortality occurred in 9.7% of infants overall (N = 39/401), of which 61.5% (24/39) occurred within 48 hours of admission. Mortality was higher in infants with bacterial sepsis compared to other infants (22.0% [9/41] versus 8.3% [30/360]; p = 0.005). All DS were associated with mortality except for temperature instability and tachypnea, whereas none of the DS were significantly associated with bacterial sepsis, except for “unable to feed” (OR 2.25; 95%CI: 1.17–4.44; p = 0.017). The number of DS predicted mortality (OR: 1.75; 95%CI: 1.43–2.17; p<0.001; AUC: 0.756), but was marginally associated with positive cultures with a neonatal pathogen (OR 1.22; 95%CI: 1.00–1.49; p = 0.046; AUC: 0.743). The association between number of DS and mortality remained significant after adjusting for admission weight, the only statistically significant co-variable (OR 1.75 [95% CI: 1.39–2.23]; p<0.001). Considering all positive cultures including potential bacterial contaminants resulted a non-significant association between number of DS and sepsis (OR 1.09 [95% CI: 0.93–1.28]; p = 0.273). In conclusion, this study shows that DS were strongly associated with death, but were marginally associated with culture-positive pathogen sepsis in a regional hospital setting. These data imply that the incidence of bacterial sepsis and attributable mortality in infants in LMIC settings may be inaccurately estimated based on clinical signs alone.
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spelling pubmed-106627222023-11-21 World Health Organization Danger Signs to predict bacterial sepsis in young infants: A pragmatic cohort study Akinseye, Omolabake Popescu, Constantin R. Chiume-Kayuni, Msandeni Irvine, Michael A. Lufesi, Norman Mvalo, Tisungane Kissoon, Niranjan Wiens, Matthew O. Lavoie, Pascal M. PLOS Glob Public Health Research Article Bacterial sepsis is generally a major concern in ill infants. To help triaging decisions by front-line health workers in these situations, the World Health Organization (WHO) has developed danger signs (DS). The objective of this study was to evaluate the extent to which nine DS predict bacterial sepsis in young infants presenting with suspected sepsis in a low-income country setting. The study pragmatically evaluated nine DS in infants younger than 3 months with suspected sepsis in a regional hospital in Lilongwe, Malawi, between June 2018 and April 2020. Main outcomes were positive blood or cerebrospinal fluid (CSF) cultures for neonatal pathogens, and mortality. Among 401 infants (gestational age [mean ± SD]: 37.1±3.3 weeks, birth weight 2865±785 grams), 41 had positive blood or CSF cultures for a neonatal pathogen. In-hospital mortality occurred in 9.7% of infants overall (N = 39/401), of which 61.5% (24/39) occurred within 48 hours of admission. Mortality was higher in infants with bacterial sepsis compared to other infants (22.0% [9/41] versus 8.3% [30/360]; p = 0.005). All DS were associated with mortality except for temperature instability and tachypnea, whereas none of the DS were significantly associated with bacterial sepsis, except for “unable to feed” (OR 2.25; 95%CI: 1.17–4.44; p = 0.017). The number of DS predicted mortality (OR: 1.75; 95%CI: 1.43–2.17; p<0.001; AUC: 0.756), but was marginally associated with positive cultures with a neonatal pathogen (OR 1.22; 95%CI: 1.00–1.49; p = 0.046; AUC: 0.743). The association between number of DS and mortality remained significant after adjusting for admission weight, the only statistically significant co-variable (OR 1.75 [95% CI: 1.39–2.23]; p<0.001). Considering all positive cultures including potential bacterial contaminants resulted a non-significant association between number of DS and sepsis (OR 1.09 [95% CI: 0.93–1.28]; p = 0.273). In conclusion, this study shows that DS were strongly associated with death, but were marginally associated with culture-positive pathogen sepsis in a regional hospital setting. These data imply that the incidence of bacterial sepsis and attributable mortality in infants in LMIC settings may be inaccurately estimated based on clinical signs alone. Public Library of Science 2023-11-21 /pmc/articles/PMC10662722/ /pubmed/37988384 http://dx.doi.org/10.1371/journal.pgph.0001990 Text en © 2023 Akinseye et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Akinseye, Omolabake
Popescu, Constantin R.
Chiume-Kayuni, Msandeni
Irvine, Michael A.
Lufesi, Norman
Mvalo, Tisungane
Kissoon, Niranjan
Wiens, Matthew O.
Lavoie, Pascal M.
World Health Organization Danger Signs to predict bacterial sepsis in young infants: A pragmatic cohort study
title World Health Organization Danger Signs to predict bacterial sepsis in young infants: A pragmatic cohort study
title_full World Health Organization Danger Signs to predict bacterial sepsis in young infants: A pragmatic cohort study
title_fullStr World Health Organization Danger Signs to predict bacterial sepsis in young infants: A pragmatic cohort study
title_full_unstemmed World Health Organization Danger Signs to predict bacterial sepsis in young infants: A pragmatic cohort study
title_short World Health Organization Danger Signs to predict bacterial sepsis in young infants: A pragmatic cohort study
title_sort world health organization danger signs to predict bacterial sepsis in young infants: a pragmatic cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10662722/
https://www.ncbi.nlm.nih.gov/pubmed/37988384
http://dx.doi.org/10.1371/journal.pgph.0001990
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