Early diagnosis of Neonatal Sepsis In Obstetric Ward: The Role of 16S rRNA Gene Sequence Analysis
Abstract
Objectives: To evaluate the role of 16S rRNA gene sequencing for rapid and sensitive diagnosis of clinically septic neonates.
Study design: Cross-sectional study.
Patients and methods: This study conducted in both NICUs of Kasr Al Ainy hospital and Children’s hospital, Cairo University over a period of three months. Fifty neonates undergoing sepsis evaluation were included in this study. Sixty-one blood samples were collected as a part of evaluation of infection, 50 samples upon admission and 11 samples as follow up due to persistence of clinical manifestations. These samples were used for both blood culture and broad range 16S rRNA polymerase chain reaction (PCR) analyses. Genotypic identification of bacteria by sequence analysis of the 16S rRNA gene was performed on all PCR positive samples.
Results: The rate of culture-proven sepsis was 19.7 %. (12/61). With the molecular method of broad range 16S rRNA PCR, the detection of bacteria improved to 29.5%(18/61). PCR revealed sensitivity, specificity, positive predictive value and negative predictive value of [91.7%, 85.4%. 61% and 97.6%] respectively, while the accuracy of this test was 86.7%. So, compared to culture, the 16S rRNA PCR demonstrated a high negative predictive value for ruling out neonatal sepsis. We found a significant association between increasing number of abnormal hematological findings and PCR positivity (p=0.006).
Conclusion: Broad range 16S rRNA PCR can be used to rule out sepsis. Both PCR and sequence analysis can provide additional diagnostic data that cannot be obtained with the use of broad-range PCR and routine laboratory tests alone.
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