Approach to Term Neonates Born After Maternal Intrapartum Fever and Unknown Maternal Group B Streptococcus Status

Makhoul, Imad R.; Sprecher, Hanna; Smolkin, Tatiana; Sawaid, Raneen; Ben-David, Shlomit; Sujov, Polo; Tamir, Ada; Kassis, Imad; Blazer, Shraga

doi:10.1097/inf.0b013e31812f5701

Cited by 4 publications

(2 citation statements)

References 11 publications

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“…In a subsequent report that evaluated 148 clinical samples in 111 neonates with sepsis after 3 days of age, Staphylococcus -specific PCR showed a sensitivity, specificity, PPV and NPV of 57.1, 94.7, 53.3 and 95.4%, respectively, compared with Staphylococcus -positive blood cultures [50]. However, Staphylococcus -specific PCR may not be useful in early-onset sepsis due to the paucity of staphylococcal infections [49]. …”

Section: Pathogen-specific Pcr Assaysmentioning

confidence: 99%

Molecular microbiological methods in the diagnosis of neonatal sepsis

Venkatesh

Flores

Luna

et al. 2010

Expert Review of Anti-infective Therapy

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Neonatal sepsis is a major cause of neonatal mortality and morbidity. The current gold standard for diagnosis of sepsis, namely blood culture, suffers from low sensitivity and a reporting delay of approximately 48-72 h. Rapid detection of sepsis and institution of antimicrobial therapy may improve patient outcomes. Rapid and sensitive tests that can inform clinicians regarding the institution or optimization of antimicrobial therapy are urgently needed. The ideal diagnostic test should have adequate specificity and negative predictive value to reliably exclude sepsis and avoid unnecessary antibiotic therapy. We comprehensively searched for neonatal studies that evaluated molecular methods for diagnosis of sepsis. We identified 19 studies that were assessed with respect to assay methodology and diagnostic characteristics. In addition, we also reviewed newer molecular microbiological assays of relevance that have not been fully evaluated in neonates. Molecular methods offer distinct advantages over blood cultures, including increased sensitivity and rapid diagnosis. However, diagnostic accuracy and cost-effectiveness should be established before implementation in clinical practice. Keywords diagnosis; FISH; microarray; molecular; neonate; PCR; sepsis Neonatal sepsis is a frequent life-threatening problem in neonatal intensive care units, particularly in very-low-birthweight infants (VLBW; infants with birthweight <1500 g) [1][2][3]. Early-onset sepsis (EOS; sepsis in infants <72 h old) occurs in 1.5-1.9% of VLBW infants, and late-onset sepsis (LOS; onset after 72 h of life) in approximately 20% [1]. Coagulasenegative staphylococci (CONS), Staphylococcus aureus and fungi are responsible for most neonatal infections [1]. Neonatal mortality in LOS is approximately 18% overall and 36% in Gram-negative sepsis. Sepsis also increases neonatal morbidities including patent ductus arteriosus, need for intravascular access, need for parenteral nutrition, bronchopulmonary † Author for correspondence: Tel.: +1 832 824 3206, Fax: +1 832 825 3204, mohanv@bcm.edu.For reprint orders, please contact reprints@expert-reviews.com Financial & competing interests disclosureFunding for color printing of the figures was provided by AdvanDx (MA, USA). Mohan Pammi Venkatesh is funded by CHRCDA grant (NIH K12 HD41648). James Versalovic is supported by R01 AT004326-01A1 NIH/NCCAM, R01 DK065075-01 NIH/NIDDK and 1UH2HG083990-01 NIH/NHGRI. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript. NIH Public Access Author ManuscriptExpert Rev Anti Infect Ther. Author manuscript; available in PMC 2011 July 1. . In a large cohort of 6093 extremely low birthweight infants (ELBW; birthweight ≤1000 g), infected infants had a significantly higher incidence of adverse developmental outc...

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Section: Pathogen-specific Pcr Assaysmentioning

confidence: 99%

Molecular microbiological methods in the diagnosis of neonatal sepsis

Venkatesh

Flores

Luna

et al. 2010

Expert Review of Anti-infective Therapy

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“…As outlined in Table 1 , the percentage of women who present at term without ROM > 18 hours ranged from 61.8 10 to 91.6% 11 in previous studies. As outlined in Table 2 , the percentage of women who present at term without MIF ranged from 97.8 10 to 99% 16 in previous studies. These percentages were used to determine the proportion of the total population of women giving birth in the United States annually who would not have been treated based on the current ACOG guidelines.…”

Section: Methodsmentioning

confidence: 82%

Universal versus Risk-Based Management of Unknown Group B Streptococcus Status at Term

Jones

Haikal

Whitham

et al. 2019

AJP Rep

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Objectives This article estimates and compares public health costs of universal versus risk-based intrapartum antibiotic prophylaxis (IAP) administration for women with unknown Group B streptococcus (GBS) status at term. Study Design The annual number of women in the U.S. who are: unscreened for GBS, without risk factors, delivering vaginally, multiparous, and eligible for discharge within 24 hours was estimated. Under the risk-based strategy, women and neonates were assumed to stay another day for observation and incur the cost of an additional 24-hour stay. With universal IAP administration, women delivering without complications were assumed to be discharged within 24 hours, with an incurred cost of penicillin. Results The estimated cost for the risk-based management of unscreened women at term without rupture of membranes (ROM) > 18 hours ranged from $468,886,831 to $850,556,179. Similarly, the cost of managing unscreened women without maternal intrapartum fever (MIF) ranged from $742,024,791 to $919,269,233. Alternatively, universal IAP administration costs ranged from $470,107,674 to $568,359,086.5. Cost comparisons yielded an equivalence or up to a 33.2% reduction in cost, and 36.6 to 38.2% reduction in cost for women without ROM > 18 hours and MIF, respectively. Conclusions Universal IAP may be cost saving due to the reduction in extended hospitalizations for neonates and healthy mothers.

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