The profile of ancillary laboratory tests in neonates with bacterial and/ or fungal sepsis
Date
2020
Authors
Sono, Lino
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Abstract
Background: Blood and cerebrospinal fluid (CSF) cultures are used as the gold standard to diagnose neonatal sepsis/meningitis. A challenge in their use is low yield, and limited availability, especially in low-resource settings. We evaluated profiles of complete blood count (CBC), c-reactive protein (CRP), and CSF cell count and protein in neonates with culture-proven sepsis/meningitis.
Methods: Neonates with positive blood and/or CSF cultures who had results of CBC, CRP, CSF cell count, and protein performed within 24-48 hours of culture were enrolled. The proportion of neonates with abnormalities in these tests was determined and comparisons among different types of pathogens were performed.
Results: A total of 942 isolates were cultured in blood and/or CSF. Groups of organisms isolated were Gram-negatives (GN) (62.0%), Gram-positives (GP) (23.4%), and Candida (14.6%). Common abnormality in CBC was thrombocytopenia, observed in 30% of neonates with culture-proven sepsis. There was a higher proportion of thrombocytopenia among GN- (39.9%) and Candida-infected (44.6%) compared GP (15.1%)(p<0.001). Leukopenia was relatively more common among GN than GP (20.8% vs 8.4%; p < 0.001). Seventy percent had high CRP (≥10mg/L). Only 26.7% and 61.6% had abnormal CSF cell count (>20cells/mm3) and high protein (>150mg/dL) among those with positive CSF cultures.
Conclusion: The majority of neonates with positive blood or CSF cultures have normal CBC or CSF cell count respectively, therefore the absence of abnormalities in these parameters cannot be used solely to exclude sepsis. CRP appears to be the most useful test in diagnosing sepsis as it is abnormal in 70% of patients with culture-proven sepsis.
Description
A dissertation submitted in fulfilment of the requirements for the degree of Masters in Medicine to the faculty of Health Sciences, University of the Witwatersrand, School of Clinical Medicine, Johannesburg, 2020