Sean O. Whelan (Ireland)
GUH Dept of Clinical MicrobiologyAuthor Of 2 Presentations
A REVIEW OF LUMBAR PUNCTURES PERFORMED FOR EARLY ONSET NEONATAL SEPSIS IN NEONATES OF 35 WEEKS GESTATION OR GREATER IN A TERTIARY NEONATAL UNIT BETWEEN 2016 AND 2020
Abstract
Backgrounds:
Early onset sepsis (EOS) is a diagnostically challenging clinical concern in neonatology. We sought to ascertain the incidence of EOS in our unit, and to examine the role of lumbar puncture (LP) in EOS evaluation, including the use of CRP as an indication.
Methods
A retrospective electronic chart review of neonates who were born in CUMH at greater than 35 weeks gestational age from 01/01/2016-31/12/2020 who underwent a LP due to concern for EOS. Neonates were identified based on electronic chart pharmacy records of receiving 3+ days of IV benzylpenicilin or cefotaxime, correlated with laboratory reports for LP.
Results:
676 neonates were treated for greater than 3 days with intravenous antibiotics due to concern for EOS (23/1000). 205 LPs were undertaken (7/1000). In 41 cases (20%) CSF was either not obtained, or was too bloodstained for microscopy. 18 neonates had proven bacteraemia (0.62/1000). There were 6 cases of culture/PCR negative CSF with a high cell count concerning for ventriculitis and 1 case of culture positive group B streptococcus meningitis in the setting of bacteraemia with the same organism. The incidence of confirmed or suspected bacterial meningitis was 0.24/1000.
Conclusions/Learning Points:
In neonates without bacteraemia or signs of meningism, none had suspected or confirmed bacterial meningitis with a pre-LP CRP less than 45 or a maximum CRP less than 50. The relative rarity of neonatal meningitis precludes definitive threshold definition by this study. However using higher CRP thresholds of 40 versus 20 in neonates without other indications for LP in this cohort would have prevented 34 LPs without missing a case of ventriculitis/meningitis. A sizable cohort (20%) in whom LP was felt indicated had failed or entirely bloodstained CSF collection, challenging diagnosis.
SYSTEMATIC REVIEW OF HOST GENOMIC BIOMARKERS OF INVASIVE BACTERIAL DISEASE: DISTINGUISHING BACTERIAL FROM NON-BACTERIAL CAUSES OF ACUTE FEBRILE ILLNESS.
Abstract
Backgrounds:
Infectious diseases play a significant role in the global burden of disease. The gold standard for the diagnosis of bacterial infection, culture of bacteria, can lead to diagnostic delays and unnecessary antibiotic use. The advent of high-throughput microarray and sequencing has led to the discovery of host-based genomic biomarkers, capable of differentiating bacterial from other causes of infection but few have achieved validation for use in a clinical setting.
Methods
A systematic review was performed. PubMed/Ovid Medline, Ovid Embase and Scopus databases were searched for relevant studies from inception up to 21/09/2020 with forward and backward citation searching of key references. Studies which compared the diagnostic performance of host genomic biomarkers of bacterial infection to those with non-bacterial sources of infection were included. Study selection and assessment of quality was conducted by two independent reviewers. Meta-analysis was undertaken for all included genomic signatures using a diagnostic random-effects model. The review was registered with PROSPERO (ID: CRD42021208462).
Results:
Sixty-eight studies which evaluated the performance of 110 biomarkers in 15,299 patients were included. Forty-seven studies examined the performance of biomarkers specific to TB infection and twenty studies were conducted in a paediatric population. The results of pooled sensitivity, specificity, negative and positive likelihood ratio and diagnostic odds ratio of genomic biomarkers of bacterial infection were 0.81 (95% CI 0.78 to 0.83), 0.86 (95% CI 0.84 to 0.88), 0.18 (95% CI 0.15 to 0.21), 5.7 (95% CI 5.0 to 6.5), 31.3 (95% CI 25 to 39), respectively. Significant heterogeneity (I2 77%) was present.
Conclusions/Learning Points:
Host derived genomic biomarkers show significant potential for clinical use as diagnostic tests of bacterial infection however, further validation and attention to test platform is warranted before clinical implementation can be achieved.
Presenter of 1 Presentation
A REVIEW OF LUMBAR PUNCTURES PERFORMED FOR EARLY ONSET NEONATAL SEPSIS IN NEONATES OF 35 WEEKS GESTATION OR GREATER IN A TERTIARY NEONATAL UNIT BETWEEN 2016 AND 2020
Abstract
Backgrounds:
Early onset sepsis (EOS) is a diagnostically challenging clinical concern in neonatology. We sought to ascertain the incidence of EOS in our unit, and to examine the role of lumbar puncture (LP) in EOS evaluation, including the use of CRP as an indication.
Methods
A retrospective electronic chart review of neonates who were born in CUMH at greater than 35 weeks gestational age from 01/01/2016-31/12/2020 who underwent a LP due to concern for EOS. Neonates were identified based on electronic chart pharmacy records of receiving 3+ days of IV benzylpenicilin or cefotaxime, correlated with laboratory reports for LP.
Results:
676 neonates were treated for greater than 3 days with intravenous antibiotics due to concern for EOS (23/1000). 205 LPs were undertaken (7/1000). In 41 cases (20%) CSF was either not obtained, or was too bloodstained for microscopy. 18 neonates had proven bacteraemia (0.62/1000). There were 6 cases of culture/PCR negative CSF with a high cell count concerning for ventriculitis and 1 case of culture positive group B streptococcus meningitis in the setting of bacteraemia with the same organism. The incidence of confirmed or suspected bacterial meningitis was 0.24/1000.
Conclusions/Learning Points:
In neonates without bacteraemia or signs of meningism, none had suspected or confirmed bacterial meningitis with a pre-LP CRP less than 45 or a maximum CRP less than 50. The relative rarity of neonatal meningitis precludes definitive threshold definition by this study. However using higher CRP thresholds of 40 versus 20 in neonates without other indications for LP in this cohort would have prevented 34 LPs without missing a case of ventriculitis/meningitis. A sizable cohort (20%) in whom LP was felt indicated had failed or entirely bloodstained CSF collection, challenging diagnosis.