Predictive value of quantitative procalcitonin in nosocomial neonatal sepsis.

Abstract

Objective:.  To find out the predictive value of quantitative procalcitonin as a marker of nosocomial neonatal sepsis.

Participants: The study enrolled all the neonates admitted to this hospital with first-day septic workup negative.

Study Design: Observational study.

Methods: All the neonates fulfilling the inclusion criteria were enrolled for the study, in addition to the physical and clinical examination, the patients were subject to the following investigations with techniques and standards mentioned underneath:

1. Complete Blood Count (CBC).
2. Blood culture using the BACTEC method.
3. Urine culture and analysis.
4. Chest X-ray.

1. CSF analysis and culture was done in case of suspected meningitis.
2. PCT was measured by a fluorescence immunoassay using QDX Instacheck. A quantitative test requiring 150 μl of serum. The signal intensity of fluorescence on detector antibody reflected the amount of antigen captured and was processed by QDX Instacheck Reader. The detection limit was 0.25-100ng/ml. The normal serum procalcitonin with this was<0.5ng/ml

 Results: Out of 42 patients, 29 patients were culture positive and 13 patients were culture negative. In our study, we aimed to define a cutoff for PCT in the blood that can be called significant for culture-positive nosocomial sepsis in neonates. We observed, at a PCT value of 1.5ng/ml, the serum PCT has a sensitivity, specificity, PPV, and NPV of 93.1%, 84.6%, 85.79%, and 92.3% in predicting positive blood culture in nosocomial neonatal sepsis with a p-value of 0.007.

Conclusion: Elevated serum PCT level is a good tool to diagnose nosocomial sepsis and in case of clinical deterioration, a treating physician can modify the regimen based on elevated PCT levels. This can improve neonatal survival, as delay in antibiotic therapy may lead to the poor final outcomes.