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Management of neonatal sepsis at Muhimbili National Hospital in Dar es Salaam: diagnostic accuracy of C – reactive protein and newborn scale of sepsis and antimicrobial resistance pattern of etiological bacteria

BACKGROUND: We determined the accuracy of Rubarth’s newborn scale of sepsis and C- reactive protein in diagnosing neonatal sepsis and assessed antimicrobial susceptibility pattern of etiological bacteria. METHODS: This cross sectional study was conducted at Muhimbili National Hospital in Dar es Sala...

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Autores principales: Mkony, Martha Franklin, Mizinduko, Mucho Michael, Massawe, Augustine, Matee, Mecky
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4262228/
https://www.ncbi.nlm.nih.gov/pubmed/25475836
http://dx.doi.org/10.1186/s12887-014-0293-4
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author Mkony, Martha Franklin
Mizinduko, Mucho Michael
Massawe, Augustine
Matee, Mecky
author_facet Mkony, Martha Franklin
Mizinduko, Mucho Michael
Massawe, Augustine
Matee, Mecky
author_sort Mkony, Martha Franklin
collection PubMed
description BACKGROUND: We determined the accuracy of Rubarth’s newborn scale of sepsis and C- reactive protein in diagnosing neonatal sepsis and assessed antimicrobial susceptibility pattern of etiological bacteria. METHODS: This cross sectional study was conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania between July 2012 and March 2013. Neonates suspected to have sepsis underwent physical examination using Rubarth’s newborn scale of sepsis (RNSOS). Blood was taken for culture and antimicrobial sensitivity testing, full blood picture and C – reactive protein (CRP) performed 12 hours apart. The efficacy of RNSOS and serial CRP was assessed by calculating sensitivity, specificity, negative and positive predictive values, receiver operating characteristics (ROC) analysis as well as likelihood ratios (LHR) with blood culture result used as a gold standard. RESULTS: Out of 208 blood samples, 19.2% had a positive blood culture. Single CRP had sensitivity and specificity of 87.5% and 70.9% respectively, while RNSOS had sensitivity of 65% and specificity of 79.7%. Serial CRP had sensitivity of 69.0% and specificity of 92.9%. Combination of CRP and RNSOS increased sensitivity to 95.6% and specificity of 56.4%. Combination of two CRP and RNSOS decreased sensitivity to 89.1% but increased specificity to 74%. ROC for CRP was 0.86; and for RNSOS was 0.81. For CRP the LHR for positive test was 3 while for negative test was 0.18, while for RNSOS the corresponding values were 3.24 and for negative test was 0.43. Isolated bacteria were Klebsiella spp 14 (35%), Escherichia coli 12 (22.5%), Coagulase negative staphlococci 9 (30%), Staphylococcus aureus 4 (10%), and Pseudomonas spp 1 (2.5%). The overall resistance to the WHO recommended first line antibiotics was 100%, 92% and 42% for cloxacillin, ampicillin and gentamicin, respectively. For the second line drugs resistance was 45%, 40%, and 7% for ceftriaxone, vancomycin and amikacin respectively. CONCLUSIONS: Single CRP in combination with RNSOS can be used for rapid identification of neonates with sepsis due to high sensitivity (95.6%) but cannot exclude those without sepsis due to low specificity (56.4%). Serial CRP done 12hrs apart can be used to exclude non-cases. This study demonstrated very high levels of resistance to the first-line antibiotics.
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spelling pubmed-42622282014-12-11 Management of neonatal sepsis at Muhimbili National Hospital in Dar es Salaam: diagnostic accuracy of C – reactive protein and newborn scale of sepsis and antimicrobial resistance pattern of etiological bacteria Mkony, Martha Franklin Mizinduko, Mucho Michael Massawe, Augustine Matee, Mecky BMC Pediatr Research Article BACKGROUND: We determined the accuracy of Rubarth’s newborn scale of sepsis and C- reactive protein in diagnosing neonatal sepsis and assessed antimicrobial susceptibility pattern of etiological bacteria. METHODS: This cross sectional study was conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania between July 2012 and March 2013. Neonates suspected to have sepsis underwent physical examination using Rubarth’s newborn scale of sepsis (RNSOS). Blood was taken for culture and antimicrobial sensitivity testing, full blood picture and C – reactive protein (CRP) performed 12 hours apart. The efficacy of RNSOS and serial CRP was assessed by calculating sensitivity, specificity, negative and positive predictive values, receiver operating characteristics (ROC) analysis as well as likelihood ratios (LHR) with blood culture result used as a gold standard. RESULTS: Out of 208 blood samples, 19.2% had a positive blood culture. Single CRP had sensitivity and specificity of 87.5% and 70.9% respectively, while RNSOS had sensitivity of 65% and specificity of 79.7%. Serial CRP had sensitivity of 69.0% and specificity of 92.9%. Combination of CRP and RNSOS increased sensitivity to 95.6% and specificity of 56.4%. Combination of two CRP and RNSOS decreased sensitivity to 89.1% but increased specificity to 74%. ROC for CRP was 0.86; and for RNSOS was 0.81. For CRP the LHR for positive test was 3 while for negative test was 0.18, while for RNSOS the corresponding values were 3.24 and for negative test was 0.43. Isolated bacteria were Klebsiella spp 14 (35%), Escherichia coli 12 (22.5%), Coagulase negative staphlococci 9 (30%), Staphylococcus aureus 4 (10%), and Pseudomonas spp 1 (2.5%). The overall resistance to the WHO recommended first line antibiotics was 100%, 92% and 42% for cloxacillin, ampicillin and gentamicin, respectively. For the second line drugs resistance was 45%, 40%, and 7% for ceftriaxone, vancomycin and amikacin respectively. CONCLUSIONS: Single CRP in combination with RNSOS can be used for rapid identification of neonates with sepsis due to high sensitivity (95.6%) but cannot exclude those without sepsis due to low specificity (56.4%). Serial CRP done 12hrs apart can be used to exclude non-cases. This study demonstrated very high levels of resistance to the first-line antibiotics. BioMed Central 2014-12-05 /pmc/articles/PMC4262228/ /pubmed/25475836 http://dx.doi.org/10.1186/s12887-014-0293-4 Text en © Mkony et al.; licensee BioMed Central Ltd. 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Mkony, Martha Franklin
Mizinduko, Mucho Michael
Massawe, Augustine
Matee, Mecky
Management of neonatal sepsis at Muhimbili National Hospital in Dar es Salaam: diagnostic accuracy of C – reactive protein and newborn scale of sepsis and antimicrobial resistance pattern of etiological bacteria
title Management of neonatal sepsis at Muhimbili National Hospital in Dar es Salaam: diagnostic accuracy of C – reactive protein and newborn scale of sepsis and antimicrobial resistance pattern of etiological bacteria
title_full Management of neonatal sepsis at Muhimbili National Hospital in Dar es Salaam: diagnostic accuracy of C – reactive protein and newborn scale of sepsis and antimicrobial resistance pattern of etiological bacteria
title_fullStr Management of neonatal sepsis at Muhimbili National Hospital in Dar es Salaam: diagnostic accuracy of C – reactive protein and newborn scale of sepsis and antimicrobial resistance pattern of etiological bacteria
title_full_unstemmed Management of neonatal sepsis at Muhimbili National Hospital in Dar es Salaam: diagnostic accuracy of C – reactive protein and newborn scale of sepsis and antimicrobial resistance pattern of etiological bacteria
title_short Management of neonatal sepsis at Muhimbili National Hospital in Dar es Salaam: diagnostic accuracy of C – reactive protein and newborn scale of sepsis and antimicrobial resistance pattern of etiological bacteria
title_sort management of neonatal sepsis at muhimbili national hospital in dar es salaam: diagnostic accuracy of c – reactive protein and newborn scale of sepsis and antimicrobial resistance pattern of etiological bacteria
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4262228/
https://www.ncbi.nlm.nih.gov/pubmed/25475836
http://dx.doi.org/10.1186/s12887-014-0293-4
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