Rectal screening displays high negative predictive value for bloodstream infection with (ESBL-producing) Gram-negative bacteria in neonates with suspected sepsis in a low-resource setting neonatal care unit

Autor: Michiel Lekkerkerker, Marine Berthet, Cono Ariti, Kessiane Charles, Joost Hopman, Collette Badjo, Heiman F. L. Wertheim, Annick Lenglet, Emily Borgundvaag, Rodnie Senat-Delva, Melissa McRae, Estiver Evens, Kate Clezy, Jorien Schuurmans
Rok vydání: 2020
Předmět:
0301 basic medicine
Microbiology (medical)
medicine.medical_specialty
Gram-negative bacteria
Concordance
030106 microbiology
Immunology
Predictive value
Bacteremia
Microbiology
Gastroenterology
beta-Lactamases
Sepsis
03 medical and health sciences
All institutes and research themes of the Radboud University Medical Center
Neonate
0302 clinical medicine
Predictive Value of Tests
Internal medicine
Gram-Negative Bacteria
medicine
Immunology and Allergy
Humans
Blood culture
030212 general & internal medicine
Rectal swab
biology
Neonatal sepsis
medicine.diagnostic_test
business.industry
Infant
Newborn
Outbreak
Klebsiella oxytoca
Late-onset sepsis
biology.organism_classification
medicine.disease
Haiti
QR1-502
Confidence interval
lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4]
business
Gram-Negative Bacterial Infections
Zdroj: Journal of Global Antimicrobial Resistance, Vol 23, Iss, Pp 102-107 (2020)
Journal of Global Antimicrobial Resistance, 23, 102-107
Journal of Global Antimicrobial Resistance, 23, pp. 102-107
ISSN: 2213-7165
DOI: 10.1016/j.jgar.2020.08.017
Popis: Objectives\ud\udWe analysed the concordance of rectal swab isolates and blood culture for Gram-negative bacteria (GNB) isolates in neonates with a suspicion of neonatal sepsis admitted to a neonatal care unit in Haiti.\udMethods\ud\udWe matched pairs of blood and rectal samples taken on the date of suspected sepsis onset in the same neonate. We calculated the proportion of rectal isolates in concordance with the blood isolates by species and genus. We calculated the negative predictive value (NPV) for GNB and extended-spectrum β-lactamase (ESBL)-producing GNB for all rectal and blood isolate pairs in neonates with suspected sepsis.\udResults\ud\udWe identified 238 blood and rectal samples pairs, with 238 blood isolate results and 309 rectal isolate results. The overall concordance in genus and species between blood and rectal isolates was 22.3% [95% confidence interval (CI) 17.4–28.0%] and 20.6% (95% CI 16.0–26.2%), respectively. The highest concordance between blood and rectal isolates was observed for samples with no bacterial growth (65%), followed byKlebsiella pneumoniae (18%) and Klebsiella oxytoca (12%). The NPV of detecting GNB bacterial isolates in rectal samples compared with those in blood samples was 81.6% and the NPV for ESBL-positive GNB was 92.6%.\udConclusions\ud\udThe NPV of rectal swab GNB isolates was high in all patient groups and was even higher for ESBL-positive GNB. Clinicians can use the results from rectal swabs when taken simultaneously with blood samples during outbreaks to inform the (de-)escalation of antibiotic therapy in those neonates that have an ongoing sepsis profile.
Databáze: OpenAIRE
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