Rectal screening displays high negative predictive value for bloodstream infections with (ESBL-producing) gram negative bacteria in neonates with suspected sepsis in a low-resource setting neonatal care unit.

Sep 7, 2020

Contributor: Annick Lenglet,Jorien Schuurmans,Cono Ariti,Emily Borgundvaag,Kessiane Charles,Collette Badjo,Kate Clezy,Estiver Evens,Rodnie Senat-Delva,Marine Berthet,Michiel Lekkerkerker,Melissa McRae,Heiman Wertheim,Joost Hopman

Rectal screening displays high negative predictive value for bloodstream infections with (ESBL-producing) gram negative bacteria in neonates with suspected sepsis in a low-resource setting neonatal care unit.

We analyzed the concordance of rectal swab isolates and blood culture for gram negative bacteria (GNB) isolates in neonates with suspicion of neonatal sepsis admitted to a neonatal care unit in Haiti.
We matched pairs of blood and rectal samples taken on the date of suspected sepsis onset in the same neonate. We calculated the proportion of rectal isolates in concordance with the blood isolates by species and genus. We calculated the negative predictive value (NPV) for GNB and Extended Spectrum Beta Lactamase (ESBL) producing GNB for all rectal and blood isolate pairs in suspected sepsis neonates.
We identified 238 blood and rectal samples pairs with 238 blood isolate results and 309 rectal isolate results. The overall concordance in genus and species between blood and rectal isolates was 22.3% (95%CI: 48 17.4-28.0) and 20.6% (95%CI: 16.0-26.2) respectively. The highest concordance between blood and rectal isolates was observed for samples with no bacterial growth (65%) followed by Klebsiella pneumonia (18%) and Klebsiella oxytoca (12%). The NPV of detecting GNB bacterial isolates in rectal samples compared to those in blood samples was 81.6% and the NPV for ESBL positive GNB was 92.6%.
The NPV of rectal swab GNB isolates was high in all patient groups and even higher for ESBL positive GNB. Clinicians can use the results from rectal swabs when taken simultaneously with blood samples during outbreaks to inform the (de-)escalation of antibiotic therapy in those neonates that have an ongoing sepsis profile.

Copyright © 2020. Published by Elsevier Ltd.

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About The Expert

Annick Lenglet

Médecins Sans Frontières, Amsterdam, The Netherlands; Medical Microbiology Department and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands; Department of Patient Safety and Quality, Radboudumc, Nijmegen, The Netherlands. Electronic address: annick.lenglet@amsterdam.msf.org.

Jorien Schuurmans

Médecins Sans Frontières, Port au Prince, Haiti; Department of Patient Safety and Quality, Radboudumc, Nijmegen, The Netherlands. Electronic address: Jorien.schuurmans@amsterdam.msf.org.

Cono Ariti

Centre for Medical Education, Cardiff University School of Medicine, Cardiff, UK; Department of Patient Safety and Quality, Radboudumc, Nijmegen, The Netherlands. Electronic address: AritiC@cardiff.ac.uk.

Emily Borgundvaag

Médecins Sans Frontières, Port au Prince, Haiti; Department of Patient Safety and Quality, Radboudumc, Nijmegen, The Netherlands. Electronic address: eborgundvaag@gmail.com.

Kessiane Charles

Médecins Sans Frontières, Port au Prince, Haiti; Department of Patient Safety and Quality, Radboudumc, Nijmegen, The Netherlands. Electronic address: kessiglyta01@yahoo.fr.

Collette Badjo

Médecins Sans Frontières, Port au Prince, Haiti; Department of Patient Safety and Quality, Radboudumc, Nijmegen, The Netherlands. Electronic address: badjocol@yahoo.fr.

Kate Clezy

Médecins Sans Frontières, Amsterdam, The Netherlands; Department of Patient Safety and Quality, Radboudumc, Nijmegen, The Netherlands. Electronic address: kate.clezy@amsterdam.msf.org.

Estiver Evens

Médecins Sans Frontières, Port au Prince, Haiti; Department of Patient Safety and Quality, Radboudumc, Nijmegen, The Netherlands. Electronic address: estiverneevens83@yahoo.fr.

Rodnie Senat-Delva

Médecins Sans Frontières, Port au Prince, Haiti; Department of Patient Safety and Quality, Radboudumc, Nijmegen, The Netherlands. Electronic address: rodsenad21@yahoo.fr.

Marine Berthet

Médecins Sans Frontières, Port au Prince, Haiti; Department of Patient Safety and Quality, Radboudumc, Nijmegen, The Netherlands. Electronic address: toupymarin@yahoo.fr.

Michiel Lekkerkerker

Médecins Sans Frontières, Amsterdam, The Netherlands; Department of Patient Safety and Quality, Radboudumc, Nijmegen, The Netherlands. Electronic address: Michiel.lekkerkerker@amsterdam.msf.org.

Melissa McRae

Médecins Sans Frontières, Amsterdam, The Netherlands; Department of Patient Safety and Quality, Radboudumc, Nijmegen, The Netherlands. Electronic address: Melissa.mcrae@amsterdam.msf.org.

Heiman Wertheim

Medical Microbiology Department and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands; Department of Patient Safety and Quality, Radboudumc, Nijmegen, The Netherlands. Electronic address: Heiman.Wertheim@radboudumc.nl.

Joost Hopman

Médecins Sans Frontières, Amsterdam, The Netherlands; Medical Microbiology Department and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands; Médecins Sans Frontières, Port au Prince, Haiti; Department of Patient Safety and Quality, Radboudumc, Nijmegen, The Netherlands. Electronic address: Joost.Hopman@radboudumc.nl.

References

PubMed