Dongen O R E, van Leeuwen L M, de Groot P K, Vollebregt K, Schiering I, Wevers B A, Euser S M, van Houten M A
Department of Paediatrics, Spaarne Hospital, Haarlem, Netherlands.
Department of Paediatrics, Willem Alexander Children Hospital, Leiden University Medical Center, Leiden, Netherlands.
Front Pediatr. 2021 Dec 10;9:779663. doi: 10.3389/fped.2021.779663. eCollection 2021.
Up to 7% of neonates born in high-income countries receive antibiotics for suspected early-onset sepsis (EOS). Culture-proven neonatal sepsis has a prevalence of 0.2%, suggesting considerable overtreatment. We studied the diagnostic accuracy of umbilical cord blood and infant blood procalcitonin (PCT) in diagnosing EOS to improve antibiotic stewardship. Umbilical cord blood PCT was tested in newborns ≥ 32 weeks of gestation. Groups were defined as following: A) culture-proven or probable EOS ( = 25); B) Possible EOS, based on risk factors for which antibiotics were administered for <72 h ( = 49); C) Risk factor(s) for EOS without need for antibiotic treatment ( = 181); D) Healthy controls ( = 74). Additionally, venous or capillary blood PCT and C-reactive protein (CRP) were tested if blood drawing was necessary for standard care. Between June 2019 and March 2021, 329 newborns were included. Umbilical cord blood PCT was significantly higher in group A than in group C and D. No difference between venous or arterial samples was found. Sensitivity and specificity for cord blood procalcitonin were 83 and 62%, respectively (cut-off 0.1 ng/mL). Antepartum maternal antibiotic administration was associated with decreased PCT levels in both cord blood and infant blood directly postpartum in all groups combined. Umbilical cord blood PCT levels are increased in newborns ≥32 weeks with a proven or probable EOS and low in newborns with risk factors for infection, but PCT seems not a reliable marker after maternal antibiotic treatment. PCT could be useful to distinguish infected from healthy newborns with or without EOS risk factors.
在高收入国家，高达7%的新生儿因疑似早发型败血症（EOS）而接受抗生素治疗。经培养证实的新生儿败血症患病率为0.2%，这表明存在相当严重的过度治疗情况。我们研究了脐带血和婴儿血降钙素原（PCT）在诊断EOS中的诊断准确性，以改善抗生素管理。对妊娠≥32周的新生儿进行脐带血PCT检测。分组如下：A）经培养证实或可能为EOS（n = 25）；B）基于危险因素可能为EOS，为此给予抗生素治疗<72小时（n = 49）；C）有EOS危险因素但无需抗生素治疗（n = 181）；D）健康对照（n = 74）。此外，如果标准护理需要抽血，则检测静脉血或毛细血管血PCT及C反应蛋白（CRP）。在2019年6月至2021年3月期间，纳入了329例新生儿。A组脐带血PCT显著高于C组和D组。未发现静脉血或动脉血样本之间存在差异。脐带血降钙素原的敏感性和特异性分别为83%和62%（临界值为0.1 ng/mL）。所有组合并后，产前母亲使用抗生素与产后直接采集的脐带血和婴儿血中PCT水平降低相关。妊娠≥32周且经证实或可能为EOS的新生儿脐带血PCT水平升高，而有感染危险因素的新生儿脐带血PCT水平较低，但母亲使用抗生素治疗后，PCT似乎不是一个可靠的标志物。PCT可用于区分有或无EOS危险因素的感染新生儿和健康新生儿。
