Evaluation of Procalcitonin Test for Early Diagnosis of Neonatal Sepsis in Tikrit Teaching Hospital

Mahir Abid Al- Rasheid, Suha; R. Al-Sa&#039;adoon, Emad; J. Mohammed, Mousa; Mahmood Raoof, Waad

doi:10.37652/juaps.2010.43978

Document Type : Research Paper

Authors

¹ Tikrit University - College of Science

² Tikrit University - College of Medicine

10.37652/juaps.2010.43978

Abstract

The diagnosis of neonatal infection is challenging because traditional markers of infection
are often misleading instead of diagnosing. This study was conducted to determine Procalcitonin (PCT)
level as an early marker for diagnosis of suspected sepsis in neonates in comparison with C-reactive
protein, blood culture, total and differential white blood cell counts. From August, 2008 till March,
2009, 114 blood samples were collected from neonates (males and females) admitted to the pediatricsneonatal
wards at Tikrit Teaching Hospital who were clinically suspected with sepsis as diagnosed by
the physician in the hospital with any features suggestive of sepsis. The results of blood culture
showed that 53 (46%) of samples were positive, of them 32 (60%) were males and 21 (40%) were
females. The number of negative cases were 61 (54%), of them 31 (51%) were females and 30
(49%)were males. The results of identification showed that the most frequent bacterial isolates were
Coagulase Negative Staphylococci and Nocardia spp. (22% for each), followed by Listeria
monocytogenes 17%, Klebsiella pneumoniae, 9% Pseudomonas aeruginosa 6% and Staphylococcus
aureus 6%, while (Citrobacter diversus, Serratia marscesens, Serratia liquifascens, Lactobacillus spp.,
Peptostreptococcus spp., Micrococcus spp., Streptococcus pyogenes) were frequently less isolated
recording 2% for each .
The antibiotics susceptibility test revealed that Gram negative isolates showed high resistance to
antibiotics used in the present study. Each isolate of the Gram positive bacteria showed different
pattern of resistance against the antibiotics used. Results of virulence factor showed that 85%, 100%,
100% , 100% and 62% of Gram negative isolates and 61%, 100% , 89%, 94% and 78% of Gram
positive isolated produced Urease , Hemolysin, Lipase, Lecithinase and alkaline protease, respectively.
Results of routine hematological tests at which the differences were statistically significant showed that
33% of culture positive cases had leucopenia, 19% of cases had leukocytosis, while the rest were in the
category of normal range. For CRP, the differences were not significant among culture positive and
culture negative cases. With reference to PCT test which had been measured using the
immunochromatographic semi-quantitative method. The results showed that 21% of culture positive
cases were with PCT level with high levels distributed among levels of PCT≥0.5 ≥2 ≥10 ng/ml. As for culture negative cases, 49%
of PCT were systemic infections cannot be excluded though they were culture negative. In addition PCT results did
not fit with CRP all the time since some cases recorded higher level of PCT ≥10 ng/ml despite they
were negative for CRP. The comparison between results of PCT and WBC for the same performed
cases showed that 68% of cases were in the category of normal WBC range, meanwhile they had high
level of PCT. Only 18% were in the category of leukocytosis, and the rest of percentage were in the
category of leucopenia. When PCT was compared with other routinely measured parameters used in
this study, It seemed to be significantly more sensitive in sepsis diagnosis. Accordingly, we can
conclude that PCT is a more sensitive marker than other traditional tests (blood culture, CRP and WBC
count) that could be used in early diagnosis of bacterial sepsis in neonates

Keywords

Main Subjects

Biology

References

1-Cowan MK, Talaro KP. Microbiology a systemic approach .McGraw-Hill. Boston ;2006. p 396

2-Strange GR, Ahrens WR, Mcquillen KK, Dobiesx VA, Lee P and Prendergast HM. Pediatric emergency medicine just the facts : Section 6 Infectious Disease Emergencies .McGraw- Hill . Boston Burr Ridge;2004. P. 205-112.

3-Gladwin M, Trattler B. Clinical microbiology made ridiculously simple. 3^rd ed. MedMaster Inc. Miami ;2001.p.19.

4-Frobisher M, Hinsdill RD, Crabtree KT, Goodheart CR. Fundamentals of microbiology. 9^th ed. W. B. Saunders Co. Philadelphia ;1974.p.290.

5-Ortiz-Ruiz G, Perafản MA, Faist E, Castell CD. Sepsis . 2^nd ed. Springer .New York ;2006.p.22.

6-Parthasarathy A, Ramachandran P, and Thangavelu S. Selected Topics in Pediatrics for Practitioners .Jaypee Brothers . New Delhi ;2004.P. 28-25.

7-Behrman RE, Kliegman RM . Nel'son essentials of pediatrics .4^th ed .: Neonatal sepsis. W.B. Sauneres CO. Philadelphia . Chapter six page. 2002 : 240-244 .

8-Marino BS, Fine KS, Mcmillan JA. Blueprints pediatrics .3^{rd ed} . Blackwell publishing .Australia ;2004.P. 173-174,138-140.

9-Gupte S, Chowdhry J. Neonatal Septicemia : Current Concepts .Neonatal emergencies . 2002; 12 : 261-272.

10-Rennie JM . Roberton's Text Book of Neonatology : Part 2 Infection in the New Born.4^th ed . Elsevier Churchill livingstone .China ;2005.P. 1011-1040.

11-Rudolph AM, Kamei RK, and Overby KJ. Rodulph's fundamentals of pediatrics. 3^rd ed. Mcgrow- Hill .New York ;2002.P. 154-149.

12-Vandepitte J, Verhaegen J, Engbaek K, Rohner P, Piot P, Heuck CC. Basic laboratory procedures in clinical bacteriology. 2^nd ed. World Health Organization. Geneva ;2003.p. 14-24,71.

13-Chiena C, Panero A, Rossi N, Stegagno M, De Giusti M, Osborn JF, Pacifico L. Reliability of Procalcitonin Concentrations for the Diagnosis of Sepsis in Critically III Neonates. Clin Infect Dis. 1998; 26 : 664-672.

14-Davidsohn I, Henry JB. Clinical diagnosis by laboratory methods. 15^th ed. W. B. Saunders Co. Philadelphia ;1974.p. 1229,952,100-347.

15-Dacie JV, Lewis SM. Practical Hematology .8^th ed. Churchill Livingstone. Hong Kong ;1995.P. 17,59-61,118-121.

16-Bain BJ. A Beginner's Guide to Blood Cells . 2^nd ed. Blackwell Publishing Ltd, UK. ;2004.p. 53-63.

17-Goldman E, Green LH. Practical handbook of microbiology. 2^nd ed. CRC Press Taylor& Francis group.London ;2009. P.70-68.

18-Collee JG, Duguid JP, Fraser AG, Marmion BP, Simmons A. Mackie & McCartney Practical medical microbiology. 14^th ed. Churchill Livinstons. New York ;1996. p. 29-113.

19-Cruickshank R, Dugguid JP, Marmion BP, and Swain RH. Test for Identification of bacteria in : Medical Microbiology .12^th ed. Churchill. UK. ; 1975. p. 170-188.

20-Dey BP, Lattuada CP and Mcnamara AM. Microbiology Laboratory Guidebook. 3^rd ed. USDA/FSIS .USA ;1998.p. 59.

21-Jaggi N, Microbiology theory for MLT: Chapter 10 Bacterial Identification Jaypee Bothers. New Delhi ;2003. P. 84.

22-Burrows W. Text book of microbiology. 20^th ed. W. B. Saunders company . Philadelphia ;1973.P 587-588

23-Bauer AW, Kirby WMM, Sherris JC & Truck M, Antibiotic susceptibility testing by a standardized single disc method .Amer J Clin Pathol. 1966; 45 : 493-496.

24-Balows A, Hausler WJ, Herrmann KL, Isenderg HD, and Shadomy HJ. Manual of clinical microbiology. 5^th ed. American Society for Microbiology. Washington DC. ; 1991.p. 1244-1445,1269, 1282 ,1252,1110 ,15-17.

25-Lennette EH, Balows A, Hausler WJ, and Sandom HJ. Manual on clinical microbiology .4^th ed. American Society for Microbioloy. Washington, DC ;1985.

26-Anderson HC, McCarthy M. CRP Latex test. Am. J. Med. 1950; 8: 445.

27-Schröder J, Staubach K-H, Zabel P, Stüber F and Kremer B: Procalcitonin as a marker of severity in septic shock. Langenbecks Arch Surg. 1999; 3(84): 33-38.

28-Al-Rawi KM, Khalaf Allah AM. Design and analysis of agriculture experiments directorate of book house of publishing and pressing. Mousil University. Iraq. 1980.

29- Al-Bayaa YJ. Bacteriological Septicemia in Newborn infants. University of Baghdad/College of medicine , M .Sc. Thesis .Baghdad.2005.

30-Fuchs M, Sanyal AJ. Sepsis and Cholestasis . Clin Liver Dis. 2008; 12 :151–172.

31-Elsayed S, Kealey A, Coffin CS, Read R, Megran D, Zhang K. Nocardia cyriacigeorgica Septicemia. J Clinic Microbiol. 2006; 44(1): 280–282.

32-Black JG. Microbiology principle and explorations. 6th ed. John Wiley & Sons, INC. USA ;2005.P. 360.

33-Prescott LM, Harley JP, Klein DA. Microbiology. 5^th ed. McGraw-Hill . Boston ;2002.p. 259.

34-Furumura MT, Figueiredo PM, Carbonel GV, Darini AC, Yano T. Virulence-Associated Characteristics of Enterococcus Faecalis strains Isolated from Clinical sources. Brazili J of Microbiol. 2006; 37:230-236.

35- Ali MJ. Microbiological and epidemiological study of Urinary Tract Infection in children in Al-Hawija distriet .Tikrit university / College of education , M .Sc. Thesis. Tikrit. 2007.(In Arabic)

36-Talaro KP, Talaro A. Foundations in Microbiology Basic Principles. 4th ed. McGraw- Hill. London ;2002.P.224.

37-Ghannoum MA. Potential Role of Phospholipases in Virulence and Fungal Pathogenesis. Americ Society for Microbiol . 2000; 13(1) : 122–143.

38-Atlas RM. Principles of microbiology . Mosby . Chicago. 1995.P. 507-208.

39-Hamadh Yh . Bacteriological and genetical study on Staphylococcus aureus isolates from wound infections .Tikrit university / college of education , M .Sc. Thesis. Tikrit. 2008 .(In Arabic).

40-Rahme LG, Ausubel FM, Cao H, Drenkard E, Goumnerov BC, Lau GW, Mahajan-Miklos SH et al. Plants and animals share functionally common bacterial virulence factors. PNAS. 2000; 97(16) : 8815–8821.

41-Gomella TL, Cunningham MD, Eyal FG, Zenk KE. Neonatology management , procedures, on-call problems, diseases and drug. 5^th ed. Lange Medical Books Books/ McGraw- Hill ;2004. P.135.

42-Burner R, Pelz K, Wilhelm Ch, Funkee A, Leititis JU, Brandis M. Fatal Sepsis Caused by Corynebacterium amycolatumin a Premature Infant. J. CLIN. MICROBIOL.1997; 53(4) : 1011-1012.

43-Al-Jashaami AM. Bacteriological study on febrile children under five years of age in Tikrit teaching hospital . Tikrit university / College of medicine , M .Sc. Thesis .Tikrit .2007. Cited by: Blackburn S. Immune system and host defense mechanisms in maternal , fetal and neonatal physiology : A clinical perspective. 2^nd ed. Philadelphia. Saunders ;2002. p. 471,14.

44-Simon L, Gauvin F, Amre Dk, aint-Louis P, Lacroix J. Serum Procalcitonin and C-Reactive Protein levels as markers of bacterial infection: A systematic review and meta-analysis . Clinical Infectious Diseases. 2004; 39:206–217.

45-Meisner M. Biomarkers of sepsis : clinically useful? . Current Opinion in Critical Care. 2005; 11(5) : 473-480.

46-Ivančević N, Radenković D, Bumbaširević V, Karamarković A, Jeremić V, Kalezić N, Vodnik T, et al . Procalcitonin in preoperative diagnosis of abdominal sepsis . Langenbeck's Arch Surg. 2007; 39(3) : 397-403.

47-Jimenez AJ, Palomo De Los Reyes MJ, Diaz-Miguel RO, Guerrero AP, Miguez RP and Martinez SR.Utility of procalcitonin and C-reactive protein in the septic patient in the emergency department. Emergencias. 2009; 21: 23-27.

48-Sachse C, Dressler F, Henkel E. Increased Serum Procalcitonin in Newborn Infants without Infection . clinic chemist. 1998; 44(6) : 1343-1344.

49-Pugin J, Meisner M, Lēon A, Gendrel D, Lōpez AF. Guide for the clinical use of PCT in diagnosis and monitoring of sepsis. 6^th ed. B.R.A.H.M.S Aktiengesellschaft .Germany ;2007.p.4-23.

50-Meisner M. Procalcitonin (PCT)- A new, innovate infection parameter. Bioclinical and clinical aspects. ISMN: 3-13-105504-0, Thieme Stuttgart . New York ;2000.

51-Zahedpasha Y, AhmadpourKacho M, Hajiahmadi M, Haghshenas M. Procalcitonin as a marker of neonatal sepsis. Iran J Pediatr. 2009; 19(2) : 117-122.

52-Sponholz C, Sakr Y, Reinhart K and Brunkhorst F. Diagnostic value and prognostic implications of serum procalcitonin after cardiac surgery: a systematic review of the literature. Critic. Care. 2006; 10(5) : 1-11.

53-James M, Marie-Louise N. Congenital and perinatal infections : prevention, diagnosis and treatment. Cambridge University Press.2000. P.321-332.

54-Kofteridis DP, Samonis G, Karatzanis AD, Fragiadakis GM, Bourolias CA, Maraki S, Papadakis JA and Velegrakis GA. C-Reactive Protein and Serum Procalcitonin Levels as Markers of Bacterial Upper Respiratory Tract Infections. Am. J. Infect. Dis. 2009; 5(4) : 292-297.

Journal of University of Anbar for Pure Science

Evaluation of Procalcitonin Test for Early Diagnosis of Neonatal Sepsis in Tikrit Teaching Hospital

References

References

Volume 4, Issue 3
December 2010
Page 1-13

Evaluation of Procalcitonin Test for Early Diagnosis of Neonatal Sepsis in Tikrit Teaching Hospital

References

References

Volume 4, Issue 3December 2010Page 1-13

Volume 4, Issue 3
December 2010
Page 1-13