PDF(Pubmed)
Abstract：
Objectives: Neonatal late-onset sepsis work-up is a frequent occurrence in every neonatal department. Blood cultures are the diagnostic gold standard, however, a negative culture prior to 48-72 h is often considered insufficient to exclude sepsis. We aimed to develop a decision tree which would enable exclusion of late-onset sepsis within 24 h using clinical and laboratory variables. Study Design: Infants evaluated for late-onset sepsis during the years 2016-2019, without major malformations, in a tertiary neonatal center were eligible for inclusion. Blood cultures and clinical and laboratory data were extracted at 0 and 24 h after sepsis work-up. Infants with bacteriologically confirmed late-onset sepsis were compared to matched control infants. Univariate logistic regression identified potential risk factors. A decision tree based on Chi-square automatic interaction detection methodology was developed and validated. Results: The study cohort was divided to a development cohort (105 patients) and a validation cohort (60 patients). At 24 h after initial evaluation, the best variables to identify sepsis were C-reactive protein > 0.75 mg/dl, neutrophil-to-lymphocyte ratio > 1.5 and sick-appearance at 24 h. Use of these 3 variables together with blood culture status at 24 h, enabled identification of all infants that eventually developed sepsis through the decision tree model. Our decision tree has an area under the receiver operating characteristic curve of 0.94 (95% CI: 0.90-0.98). Conclusions: In non-sick appearing infants with a negative blood culture at 24 h and normal laboratory values, sepsis is highly unlikely and discontinuing antibiotics after 24 h is a viable option.
摘要：
目的：新生儿迟发性败血症检查在每个新生儿科都很常见。血培养是诊断的黄金标准,然而,在48-72小时之前的阴性培养通常被认为不足以排除败血症。我们旨在开发一种决策树，该决策树可以使用临床和实验室变量在24小时内排除迟发性败血症。研究设计：在2016-2019年期间评估婴儿的晚发性败血症，没有重大畸形，在三级新生儿中心有资格纳入.在脓毒症检查后0和24小时提取血培养物以及临床和实验室数据。将细菌学证实为迟发性败血症的婴儿与匹配的对照婴儿进行比较。单因素logistic回归确定了潜在的危险因素。建立了基于卡方自动交互检测方法的决策树,并进行了验证。结果：研究队列分为发展队列（105例患者）和验证队列（60例患者）。初始评估后24小时，确定脓毒症的最佳变量是C反应蛋白>0.75mg/dl，中性粒细胞与淋巴细胞的比率>1.5，并且在24小时时出现病态。使用这3个变量以及24小时时的血液培养状态，能够通过决策树模型识别所有最终发展为败血症的婴儿。我们的决策树在接收器工作特性曲线下的面积为0.94（95％CI：0.90-0.98）。结论：在24小时血培养阴性且实验室值正常的非患病婴儿中，脓毒症极不可能发生，24小时后停用抗生素是一个可行的选择。
