Delcò Cristina, Karam Oliver, Pfister Riccardo, Gervaix Alain, Renzi Gesuele, Emonet Stéphane, Schrenzel Jacques, Posfay-Barbe Klara M
Children's University Hospitals of Geneva, Geneva, Switzerland.
Children's University Hospitals of Geneva, Geneva, Switzerland.
Early Hum Dev. 2017 May;108:17-22. doi: 10.1016/j.earlhumdev.2017.03.004. Epub 2017 Mar 23.
Sepsis is an important cause of morbidity and mortality in neonates and clinicians are typically required to administer empiric antibiotics while waiting for blood culture results. However, prolonged and inappropriate use of antibiotics is associated with various complications and adverse events. Better tools to rapidly rule out bacterial infections are therefore needed.
We aimed to assess the negative predictive value of PCR coupled with Electrospray Ionization Mass Spectrometry (PCR/ESI-MS) compared to conventional blood cultures in neonatal sepsis.
Prospective observational study.
All consecutive neonates (<28days old) with clinical suspicion of sepsis. Samples for PCR/ESI-MS analysis were collected at the same time as samples for the blood culture, before the initiation of antibiotics.
Our primary objective was to evaluate the negative predictive value of PCR/ESI-MS for the detection of bacteria in the bloodstream of newborns with suspected sepsis. Our secondary objective was the evaluation of the sensitivity, specificity and positive predictive value of the PCR/ESI-MS in such a neonatal population.
We analysed 114 samples over 14months. The median age and weight were 32weeks+3days and 1840g, respectively. Two patients had negative PCR/ESI-MS results, but positive blood cultures. Overall, the negative predictive value was 98% (95%CI: 92% to 100%).
Based on these results, PCR/ESI-MS analysis of blood samples of neonates with suspected sepsis appears to have a very good negative predictive value when compared to blood cultures as gold standard. This novel test might allow for early reassessment of the need for antibiotics.
脓毒症是新生儿发病和死亡的重要原因，临床医生通常需要在等待血培养结果期间给予经验性抗生素治疗。然而，抗生素的长期和不当使用会引发各种并发症和不良事件。因此，需要更好的工具来快速排除细菌感染。
我们旨在评估聚合酶链反应（PCR）结合电喷雾电离质谱法（PCR/ESI-MS）与传统血培养相比在新生儿脓毒症中的阴性预测值。
前瞻性观察研究。
所有临床怀疑患有脓毒症的连续新生儿（<28天）。在开始使用抗生素之前，采集用于PCR/ESI-MS分析的样本，同时采集血培养样本。
我们的主要目标是评估PCR/ESI-MS对疑似脓毒症新生儿血流中细菌检测的阴性预测值。次要目标是评估PCR/ESI-MS在这类新生儿群体中的敏感性、特异性和阳性预测值。
我们在14个月内分析了114份样本。中位年龄和体重分别为32周+3天和1840克。两名患者PCR/ESI-MS结果为阴性，但血培养结果为阳性。总体而言，阴性预测值为98%（95%CI：92%至100%）。
基于这些结果，与作为金标准的血培养相比，对疑似脓毒症新生儿的血样进行PCR/ESI-MS分析似乎具有非常好的阴性预测值。这项新检测可能有助于早期重新评估抗生素使用的必要性。
