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Abstract
Introduction Early Onset Neonatal Sepsis (EONS) is a major contributor to morbidity and mortality in ELBW infants. Admission surface swab cultures (SSC) form part of admission surveillance cultures, however its place in the management of EONS is questionable.
Objective To determine:
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Sensitivity, specificity and positive predictive value of SSC.
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If culture result would reflect on mean CRP value in first 72 hrs.
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If maternal swabs and mode of delivery correlated with microbiological result in the baby.
Method
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Retrospective cohort study.
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All inborn ELBW infants admitted into a Level 3 NICU from January 2010–December 2013.
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Maternal swabs; mode of delivery; infants SSC, blood cultures and mean CRP (within 72 h) were reviewed.
Result
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161 ELBW infants were admitted and all had admission SSC, CRPs and blood cultures.
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25 of 161 (15.5%) had positive SSC (Figure 1) of which 5 were mixed culture results.
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11 of 161 (6.8%) had EONS (positive blood cultures) (Table 1).
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4 of 25 (16%) of positive SSC had correlating blood culture – all of which were E coli; 1 subject had positive SSC and blood culture but did not correlate.
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There was a statistically significant association between mode of delivery and positive culture result, χ2(1) = 10.263, p = 0.001 (Figure 2).
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Sensitivity, specificity and positive predictive value for skin swab were 36.3%, 86.7% and 16% respectively.
Bacteria grown from skinj swab
Percentage of positive microbiological result for different mode of delivery
Bacteria grown from initial blood cultures
Mean CRP for different microbiological result
Conclusions
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Routine SSC is inefficient in predicting the pathogen responsible for sepsis among premature neonates.
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E coli was the predominant organism in the study and 37% of babies with positive SSC had E. coli sepsis (blood culture).
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Mean CRP was higher in positive skin ± blood culture cases. However this was statistically not significant.
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There was increased risk of EONS with Vaginal delivery.