Abstract
Background and objectivesInfection prediction scores are useful ancillary tests in determining the likelihood of neonatal hospital-acquired infection (HAI), particularly in very low birth weight (VLBW; <1,500 g) infants who are most vulnerable to HAI and have high antibiotic utilization rates. None of the existing infection prediction scores were developed for or evaluated in South African VLBW neonates.MethodsWe identified existing infection prediction scores through literature searches and assessed each score for suitability and feasibility of use in resource-limited settings. Performance of suitable scores were compared using a retrospective dataset of VLBW infants (2016–2017) from a tertiary hospital neonatal unit in Cape Town, South Africa. Sensitivity, specificity, predictive values, and likelihood ratios were calculated for each score.ResultsEleven infection prediction scores were identified, but only five were suitable for use in resource-limited settings (NOSEP1, Singh, Rosenberg, and Bekhof scores). The five selected scores were evaluated using data from 841 episodes of HAI in 659 VLBW infants. The sensitivity for the scores ranged between 3% (NOSEP1 ≥14; proven and presumed infection), to a maximum of 74% (Singh score ≥1; proven infection). The specificity of these scores ranged from 31% (Singh score ≥1; proven and presumed infection) to 100% (NOSEP1 ≥11 and ≥14, NOSEP-NEW-1 ≥11; proven and presumed infection).ConclusionExisting infection prediction scores did not achieve comparable predictive performance in South African VLBW infants and should therefore only be used as an adjunct to clinical judgment in antimicrobial decision making. Future studies should develop infection prediction scores that have high diagnostic accuracy and are feasible to implement in resource-limited neonatal units.
Highlights
In 2015, neonatal infections contributed to over 500,000 deaths worldwide, the majority of which occurred in low- and middleincome countries (LMICs) [1, 2]
Hospital-acquired infection (HAI) among preterm (
The overall objective of this study was to evaluate the performance of neonatal infection prediction scores at a large, resource-limited South African neonatal unit with a high proportion of VLBW infant deliveries
Summary
In 2015, neonatal infections contributed to over 500,000 deaths worldwide, the majority of which occurred in low- and middleincome countries (LMICs) [1, 2]. Blood culture is considered the gold standard for the diagnosis of neonatal blood stream infections; the blood culture positivity rate is low and is affected by factors such as the volume of blood inoculated, the level of bacteremia and laboratory capability [10]. Newer tests, such as interleukin, interleukin-8, procalcitonin, and real-time polymerase chain reaction (PCR) assays for bacterial detection [11, 12] have been investigated for applicability in neonates with HAI, but are not yet available in most resource-limited settings. None of the existing infection prediction scores were developed for or evaluated in South African VLBW neonates
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