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Correspondence to: Dr. Nagy A. El-Hussieny, The Department Neonatal septicemia is a potentially life-
of Pediatrics, Ahmed Maher Teaching Hospital threatening event. As part of a group of investiga-
123
124 Value of Endotracheal Aspirate Cultures Versus Blood Cultures
The level p<0.05 was considered the cut-off Table (5): Blood culture for studied cases.
value for significance.
N %
Candida 1 –ve
Fig. (1): Hematological classification of sepsis for studied
Staph. coagulase 1 2 cases.
Pseudomonas –ve 2
Discussion
Table (13): Sensitivity and specificity of early endotracheal
culture.
Sepsis is a common complication in the Neo-
natal Intensive Care Unit (NICU). It is most com-
Sensitivity Specificity PPV NPV mon in the smallest and most premature infants,
in whom the clinical presentation can be subtle
Early endotracheal 62.5 82.4 62.5 82.4
and nonspecific. The incidence of neonatal sepsis
culture
is 1-5per 1,000 live births, and its mortality rate
is 5%-20%, Disseminated intravascular coagulation
Table (14): Comparison between organisms of late endotracheal and thrombocytopenia are well-known complica-
culture results (in the 7 th of life) versus the results tions of sepsis.
of blood cultures in the study.
Hospital acquired infections (nosocomial infec-
Blood culture Early ETT tions) are the most common complications encoun-
Organism
(+ve) culture (+ve) tered in the neonatal intensive care unit. They
Staph. aureus 2 1 generally manifest 48 hours after hospitalization
or in 48 hours after discharge, especially preterm
Klebsiella 4 10
and low birth weight newborns who are more
Candida 1 –ve vulnerable (20 to 33%) to nosocomial infections.
Staph. coagulase 1 2 Mechanically ventilated babies face a particular
Pseudomonas –ve 1 risk because artificial airways bypass the body’s
defense against inhaled pathogens and offer new
routes for non air-borne pathogens. Intubation
Table (15): Organisms detected only by late ETT. associated lesions of the pharynx and trachea lead
to bacterial colonization by the deterioration of
Organism N % the swallowing reflex and the ciliary functions.
Staph. aureus 2 20.00
Subsequently, these babies may develop pneumonia
and sepsis [1] .
Staph. epedermidis 1 10.00
Srept. viridians 3 30.00 In our study, there were no statistically signif-
icant differences between body weight (BW) &
Klebsiella 3 30.00 incidence of sepsis. Birth weight of cases ranged
Citrobacter 1 10.00 between 1000gm and 2400gm. This is in discor-
dance with [8] who found that the incidence of
Total 10 100.00 sepsis is significantly higher in infants with very
low birth weight (<1000g), at 26per 1000 live
birth, than in infants with birth weight of 1000-
Table (16): Sensitivity and specificity of late endoracheal
culture.
2000g, at 8-9per 1000 live birth.
Sensitivity Specificity PPV NPV In our study, there were no statistically signif-
icant differences between gestational ages (GA)
Late endotracheal 37.5 77.3 37.5 77.3 & incidence of sepsis. Our study agrees with [9]
culture and [10] who reported no statistically significant
Laila H. Mohamed, et al. 127
difference between sepsis and non septic groups Blood culture is the gold standard method for
as regards gestational age. isolation of the organisms; blood culture should
be obtained before the initiation of antibiotics [18] .
This is in discordance with [8] who found that
the incidence and severity of sepsis is inversely In this study, blood culture yielded +ve results
related to the gestational age of the infant. Also in 44 cases (73.3%) of ventilator associated pneu-
our study disagrees with [11] who found that the monia cases while 16 cases (26.7%) revealed a
premature neonates in particular have a relatively culture –ve output. Klebsiella was the most com-
permeable mucosal surfaces that allow for the monly detected organism (43.75%), followed by
trans-epithelial passage of bacteria and other patho- Strept. Viridians (18.75%), whilest Staph. Aureus
gens. Also loss of protective maternal antibodies, was detected in (12.5%) of cases. Staph. Epider-
as well as nonspecific alterations in macrophage midis, Candida, Staph. Coagulase and Citrobacter
phagocytes and clearance of invading pathogens, were equally detected in (6.25%) of cases each.
impaired T-cell and B-cell responses and altered
This comes in agreement with the study of [19]
production of complement and antibodies. Addi-
tionally, premature infants are at higher risk of in which nearly half of the positive blood cultures
grew Klebsiella pneumoniae. Also, the study done
progression to sepsis or severe sepsis and adverse
by [20] revealed that the isolated pathogens included
outcomes [12] .
Klebsiella pneumoniae (47.5%), Pseudomonas
In our study, the chief clinical presentations aeruginosa (20%), E.coli (10%), Candida albicans
were poor Moro’s reflex and poor suckling as well. (10%), Staphylococcus aureus (>7.5%), and En-
This is in agreement with [13] who described the terococcus (5%).
same clinical presentations as early signs of sepsis. Our results are in disagreement with a retro-
On the other hand, our study is in disagreement spective study done by [21] who studied the prev-
with the result of [14] , who reported that chest alence of different organisms causing septicemia
manifestations in the form of respiratory distress and the antibiotic susceptibility pattern. The most
are the most common and occurring in up to 90% common organism isolated was Staphylococcus
of infants with sepsis. Also [15] , found that 90% aureus (42.75%) followed by Klebsiella (18.32%),
of newborns with neonatal sepsis had respiratory E.coli (12.21%), Pseudomonas aeruginosa (6.11%);
distress in addition to symptoms of gastrointestinal also Enterobacter spp. Was isolated in (9.23%),
disturbance and poor perfusion. Acinobacter (4.62%), Streptococcal spp. In (7.69%)
In our study, we found 37 cases (62%) with a and Neisseria gonorrhea in (1.54%).
Rodwell Hematological Scoring System of sepsis In our study, 26 cases (43.3%o) showed +ve
of <2, denoting absent sepsis, 14 cases (23%) with early endotracheal tube culture (performed on day
a score of 3 denoting that sepsis is likely and 9 3), while 34 cases (56.7%o) showed –ve early ETT
cases (15%) with a score of (4-7) denoting that culture. Among the culture +ve cases, again Kleb-
sepsis is eminent. siella was the most commonly detected organism
(69.23%).
In our study, we found a significant correlation
between the duration of stay of neonates in NICU, In our study, 16 cases (26.7%) showed +ve late
prolonged stay on mechanical ventilation & inci- endotracheal tube culture, while 44 cases (73.3%)
dence of sepsis. This is in concordance with [16] showed –ve late ETT culture. Among the culture
who found that ventilator-associated pneumonia +ve cases, Klebsiella also was the most commonly
in critically ill patients is associated with longer detected organism (62.5%) followed by Strept.
ICU stays, and prolonged mechanical ventilation. Viridians, Staph. Coagluase, each detected in
(12.5%), whilest Staph. Aureus & Psendomans,
Also, this is in concordance with [17] who each detected in (6.25%) of cases.
concluded that intubation is associated with bacte-
rial colonization of the respiratory tract and, there- In the current study, If blood culture is consid-
fore, may increase the risk of acquiring an infection. ered as gold standard for diagnosis of VAP, accord-
The infection may prolong the need for mechanical ing to [22] , early endotracheal culture showed
ventilation and increase the risk of chronic lung sensitivity of 62.5% and specificity of 82.4% to
disease. The use of prophylactic antibiotics has blood culture and late endotracheal culture showed
been advocated for all mechanically ventilated sensitivity of 37.5% and specificity of 77.3% to
newborns in order to reduce the risk of colonization blood culture. Therefore early ETT culture showed
and the acquisition of infection. higher diagnostic indices than late ETT culture in
128 Value of Endotracheal Aspirate Cultures Versus Blood Cultures
detecting +ve infection (as diagnosed +ve by blood racheal cultures for detection of organisms in
culture). patients with ventilator associated pneumonia,
as tracheal aspirates may be useful track changes
This is in concordance with [1] who found that in bacterial flora at neonatal intensive care units.
blood and endotracheal cultures showed the same
organisms only in 17.6% of the patients. There References
was no relationship among 86.4% of the patients.
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