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Correspondence

Indian Pediatr 2017;54: 783-784

Simultaneous Two Site Blood Culture in Diagnosis of Neonatal Sepsis: Few Concerns: Author's Reply

 

*Amit Upadhyay and Priya Tomar

Department of Pediatrics, LLRM Medical College, Meerut, UP, India.
Email: [email protected]
 

 


We are thankful to the readers for giving us the opportunity to provide clarifications on our research.

1. Polymicrobial bacterial infections are often related to surgical interventions, complex congenital cardiac diseases, abdominal surgeries and lipid infusions [1]. We have a separate unit for surgical patients and we do not use lipid infusions for parenteral nutrition. These factors might partly explain absence of this phenomenon in our patients.

2. Difference in results from an earlier study [2] has been attributed to inclusion of outborn babies referred from other hospitals, difference in demographic features and antibiotic usage rates in developed and developing countries. However, we agree that it may also be due to gross differences in rates of culture positivity between two studies.

3. Invasive candidiasis is an emerging cause of neonatal sepsis; seen more in late onset group and in those who have received broad spectrum antibiotics. Few other Indian studies on neonatal sepsis [3,4] have also reported high incidence of candidemia. This could be explained by more number of extramural babies referred from other hospitals, and larger proportion of lower birth weight and preterm neonates.

4. Problem of false positivity can be overcome by time to culture positivity but our primary objective was to improve diagnostic yield of blood culture. We agree that multiple blood cultures may seem to increase the cost of treatment and manpower, but as it improves yield, it may lead to more rational antibiotic therapy in the unit. Early targeted therapy is essential for reducing the burden of neonatal sepsis. Delay in diagnosis or non-specific therapy may lead to antibiotic resistance.

References

1. Pammi M, Zhong D, Johnson Y, Revell P, Versalovic J. Polymicrobial bloodstream infections in the neonatal intensive care unit are associated with increased mortality: A case-control study. BMC Infect Dis. 2014;14:390.

2. Sarkar S, Bhagat I, DeCristofaro JD, Wiswell TE, Spitzer AR. A study of the role of multiple site blood cultures in the evaluation of neonatal sepsis. J Perinatol. 2005;26:18-22.

3. Rani R, Mohapatra N P, Mehta G, Randhawa VS. Changing trends of candida species in neonatal septicaemia in a tertiary North Indian hospital. Indian J Med Microbiol. 2002;20:42-4.

4. Juyal D, Sharma M, Pal S, Rathaur VK, Sharma N. Emergence of non-albicans Candida species in neonatal candidemia. N Am J Med Sci. 2013;5:541-545.

 

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