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Neonatology. 2008;94(2):123-31. doi: 10.1159/000119722. Epub 2008 Mar 7.

Routine skin cultures in predicting sepsis pathogens among hospitalized preterm neonates in Bangladesh.

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1
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md. 21205, USA.

Abstract

BACKGROUND:

Few studies from developing countries have examined sensitivity, specificity, positive and negative predictive values of routine surface cultures.

OBJECTIVES:

The purpose of the study was to determine sensitivity, specificity, and positive predictive value (PPV) of skin cultures among preterm neonates admitted to Dhaka Shishu Hospital, Bangladesh.

METHODS:

The study was nested within a prospective, randomized, controlled trial of emollient treatment in Dhaka Shishu Hospital, Bangladesh. A total of 497 preterm infants <33 weeks gestational age and <72 h of chronological age were enrolled, and the sensitivity, specificity, and PPV of skin cultures were analyzed among 3,765 blood-skin culture pairs, wherein the skin culture was obtained within 13 days before the blood culture.

RESULTS:

Overall sensitivity, specificity, and PPV were 16, 38, and 5%, respectively. PPV during Klebsiella pneumoniae outbreaks was about 9%, and the inguinal site had the highest PPV (6%) among the three skin sites. Acinetobacter spp.- and K. pneumoniae-specific PPVs were 28 and 23%, respectively. PPV was <2% for Candida spp., Enterobacter spp., and Salmonella spp.

CONCLUSION:

Routine skin culture is inefficient in predicting the pathogen responsible for sepsis among premature neonates, even in a developing country setting, where the burden of bacterial infection is relatively high. Skin cultures are also of limited utility during K. pneumoniae outbreaks, and are not recommended.

PMID:
18332641
DOI:
10.1159/000119722
[Indexed for MEDLINE]

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