Mansoura University, Department of Pediatrics, Mansoura, Egypt.
Mansoura General Hospital, Department of Pediatrics, Mansoura, Egypt.
J Pediatr (Rio J). 2018 Sep-Oct;94(5):559-565. doi: 10.1016/j.jped.2017.07.020. Epub 2017 Nov 13.
To study the microbiological pattern of late onset neonatal sepsis cultures and to assess the diagnostic performance of serum (1,3)-β-d-glucan level for early diagnosis of invasive fungemia in high-risk infants admitted to a neonatal intensive care unit.
A prospective multicenter clinical trial conducted on infants at high risk for invasive fungal infections, with suspected late onset sepsis, admitted to a neonatal intensive care unit at Mansoura University Children's Hospital and Mansoura General Hospital between March 2014 and February 2016.
A total of 77 newborn infants with high risk of invasive fungal infection were classified based on blood culture into three groups: no fungemia (41 neonates with proven bacterial sepsis), suspected fungemia (25 neonates with negative blood culture), and definite fungemia group (11 neonates with culture-proven Candida). The growing organisms were Klebsiella spp. (14/54); Escherichia coli (12/54); Staphylococcus spp. (12/54; coagulase-negative Staphylococcus [9/54]; Staphylococcus aureus [3/54]); Pseudomonas aerouginosa (3/54); and Proteus spp. (2/54). Moreover, 11/54 presented Candida. Serum (1,3)-β-d-glucan concentration was significantly lower in the no fungemia group when compared with the definite fungemia group. The best cut-off value of (1,3)-β-d-glucan was 99pg/mL with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 63.6%, 95.1%, 77.8%, 90.7%, and 88.5%, respectively.
(1,3)-β-d-glucan assay has a limited sensitivity with excellent specificity and negative predictive value, which allow its use as an aid in exclusion of invasive neonatal fungal infection. Accurate diagnosis and therapeutic decisions should be based on combining (1,3)-β-d-glucan assay with other clinical, radiological, and microbiological findings.
研究晚发型新生儿败血症培养物的微生物模式，并评估血清（1,3）-β-d-葡聚糖水平对高危新生儿侵袭性真菌感染的早期诊断的诊断性能。
对 2014 年 3 月至 2016 年 2 月间在曼苏拉大学儿童医院和曼苏拉综合医院新生儿重症监护病房因疑似晚发型败血症而住院的高危侵袭性真菌感染婴儿进行前瞻性多中心临床试验。
根据血培养结果，77 例有高危侵袭性真菌感染的新生儿分为三组：无真菌血症（41 例细菌败血症确诊患儿）、疑似真菌血症（25 例血培养阴性患儿）和明确真菌血症组（11 例培养确诊为念珠菌患儿）。生长的病原体包括克雷伯菌属（14/54）；大肠杆菌（12/54）；葡萄球菌属（12/54；凝固酶阴性葡萄球菌[9/54]；金黄色葡萄球菌[3/54]）；铜绿假单胞菌（3/54）；和变形杆菌属（2/54）。此外，54 例中有 11 例为念珠菌。与明确真菌血症组相比，无真菌血症组的血清（1,3）-β-d-葡聚糖浓度显著降低。（1,3）-β-d-葡聚糖的最佳截断值为 99pg/mL，其灵敏度、特异性、阳性预测值、阴性预测值和准确度分别为 63.6%、95.1%、77.8%、90.7%和 88.5%。
（1,3）-β-d-葡聚糖检测具有有限的灵敏度，但特异性和阴性预测值较高，可作为排除新生儿侵袭性真菌感染的辅助手段。准确的诊断和治疗决策应基于将（1,3）-β-d-葡聚糖检测与其他临床、影像学和微生物学发现相结合。
