Early diagnosis of sepsis helps make effective clinical decisions and improve the survival rate of patients with severe infection. However, the timely and accurate diagnosis of sepsis is still a great challenge in clinic. In order to settle the very problem, the scientists in the world have made a lot of exploration and research in the field of rapid molecular identification of pathogens. Nowadays, the nucleic acid detection of sepsis is mainly composed of 3 types of methodological strategies, either based on positive blood culture, single colonies, or directly on blood specimens. This paper presents a comprehensive overview of advances in the research of early detection of bacterial nucleic acid as molecular diagnosis of sepsis.
DNA, Bacterial ; blood ; Humans ; Sepsis ; blood ; diagnosis

OBJECTIVENeonatal sepsis can cause multiple organ dysfunction syndrome, especially including myocardial injury and heart failure. In this study, the authors observed the changes and the levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide in myocardial injury of neonatal sepsis at the different stages to search for the early diagnostic index of myocardial injury and heart failure in patients with neonatal septicemia.

METHODThe levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide were determined in 96 newborns with neonatal septicemia according to the diagnosis and treatment program of neonatal septicemia in 2003. The 96 cases were divided into myocardial injury group and non-myocardial injury group. Every newborn was tested for the levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide with enzyme-linked immunosorbent assay (ELISA) on the second day, fifth day and tenth day of septicemia and in the different gestational age infants. Meanwhile, the results were compared to creatine kinase isoenzyme and troponin I.

RESULTThe levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide were significantly different between myocardial injury group and non-myocardial injury group at the fifth day (P<0.05), especially the levels of plasma N-terminal pro-B-type natriuretic peptide were significantly elevated at the early stage (on the second day) between the two groups (P<0.05). On the fifth day, the values of plasma N-terminal pro-B-type natriuretic peptide were (315.5 +/- 69.7) pmol/L in myocardial injury group, but the value of non-myocardial injury group was (179.3 +/- 27.5) pmol/L. On the fifth day, the results of plasma brain natriuretic peptide, N-terminal pro-B-type natriuretic peptide and troponin I were significantly different and had statistical significance between the myocardial injury group and non-myocardial injury group (P<0.05), while the results of creatine kinase isoenzyme had no statistically significant difference (P>0.05). The values of plasma brain natriuretic peptide were respectively (215.5 +/- 69.6) pmol/L and (119.3 +/- 37.4) pmol/L, While N-terminal pro-B-type natriuretic peptide were (315.5 +/- 69.7) pmol/L and (179.3 +/- 27.5) pmol/L in the two groups. The value of troponin I was (1.57 +/- 0.39) microg/L in the myocardial injury group and that in the non-myocardial injury group was (0.55 +/- 0.2) microg/L. The values of creatine kinase isoenzyme were (33.3 +/- 10.1) u/L in the myocardial injury group, but that of non-myocardial injury group was (17.4 +/- 8.5) u/L. In the different gestational age infants, the values of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide of premature infants were the highest in the three groups. The values of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide were (159.5 +/- 39.6) pmol/L and (238.5 +/- 49.7) pmol/L in premature infants.

CONCLUSIONThe levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide evidently increased in myocardial injury of neonatal sepsis, especially in premature infants. The increase of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide may be helpful in early diagnosis of the myocardial injury of neonatal sepsis associated with cTnI. N-terminal pro-B-type natriuretic peptide may become a useful index to diagnose the myocardial injury and should be widely used in the neonatal intensive care unit.

Female ; Heart Injuries ; blood ; diagnosis ; Humans ; Infant, Newborn ; Male ; Natriuretic Peptide, Brain ; blood ; Sepsis ; blood ; diagnosis

Neonatal septicemia is one of the major causes of morbidity and mortality worldwide during the neonatal period. It can be classified into two subtypes: early-onset sepsis (EOS) and late-onset sepsis (LOS) depending upon the time of onset. In the western developed countries, group B Streptococcal and Escherichia coli are leading pathogens for EOS, while the most frequent microorganism involved in LOS is coagulase negative Staphylococci, which are different from the domestic data. Clinical manifestations of neonatal septicemia are not specific, so that it is often misdiagnosed. This review describes the progress in diagnostic methods for neonatal septicemia, including blood culture, blood cell counts, cytokine profiles and umbilical cord blood examinations. It provides useful information for early diagnosis and treatment of neonatal septicemia.
Blood Cell Count ; C-Reactive Protein ; analysis ; Calcitonin ; blood ; Cytokines ; blood ; Humans ; Infant, Newborn ; Protein Precursors ; blood ; Sepsis ; blood ; diagnosis

OBJECTIVETo explore the significance of interleukin-6 (IL-6) and IL-8 in the diagnosis of neonatal sepsis.

METHODSThis was a prospective study conducted between August 2014 and February 2015. A total of 140 neonates who were suspected infectious were enrolled and classified into a sepsis group (n=49) and a local infection group (n=91). Sixty-one neonates who were non-infectious served as the control group. Serum levels of IL-6 and IL-8 were measured before treatment and 3 days after treatment. The value of serum IL-6 and IL-8 for the diagnosis of neonatal sepsis was assessed by receiver operating characteristic (ROC) curve analysis.

RESULTSBefore treatment, serum levels of IL-6 and IL-8 in the sepsis group were higher than those in the local infection and control groups (P<0.05), and the local infection group had higher serum levels of IL-6 and IL-8 than the control group (P<0.05). After three days of treatment, the serum IL-6 level in the sepsis group remained higher than that in the local infection and control groups (P<0.05), and the local infection group had higher serum level of IL-6 than the control group (P<0.05). There was no significant difference in the serum IL-8 level among the three groups. According to the ROC curve, when the cut-off value of serum IL-6 was 32 pg/mL, the sensitivity, specificity and accuracy of serum IL-6 for the diagnosis of neonatal sepsis were 87.8%, 79.6% and 81.6% respectively; when the cut-off value of serum IL-8 was 54 pg/mL, the sensitivity, specificity and accuracy of serum IL-6 for the diagnosis of neonatal sepsis were 77.6%, 63.8% and 67.2% respectively. With the combination of serum IL-6 and IL-8 levels, the sensitivity, specificity and accuracy for the diagnosis of neonatal sepsis were 71.4%, 86.2% and 82.6% respectively.

CONCLUSIONSIL-6 and IL-8 participate in the inflammatory response and the serum levels of both vary with the severity of infection. The diagnostic value of IL-6 for neonatal sepsis is higher than IL-8. The combined detection of serum levels IL-6 and IL-8 may increase the accuracy of diagnosis of neonatal sepsis.

C-Reactive Protein ; analysis ; Female ; Humans ; Infant, Newborn ; Interleukin-6 ; blood ; Interleukin-8 ; blood ; Male ; ROC Curve ; Sepsis ; blood ; diagnosis

One of the most fearful rare complication of ureteroscopic lithotripsy is sepsis. Since sepsis after endourological maneuvers usually occur immediately after procedure, it is important to pay attention to symptoms representing sepsis such as pyrexia, tachycardia, tachypnea, and oliguria. In addition to clinical symptoms, laboratory tests including white blood cell (WBC) count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and urine and blood cultivating can help to diagnosis of sepsis. We present a case of shock after ureteroscopic lithotripsy, which was suspected with septic shock strongly.
Blood Sedimentation ; C-Reactive Protein ; Diagnosis ; Fever ; Leukocytes ; Lithotripsy* ; Oliguria ; Sepsis ; Shock* ; Shock, Septic ; Tachycardia ; Tachypnea

OBJECTIVETo evaluate the diagnostic value of interleukin 6 for neonatal sepsis.

METHODSThe databases of CNKI, VIP, Wangfang, Pubmed, Embase, Web of Science, Cochrane Library were searched (by September 2014) to identify relevantly published studies about estimating the diagnostic value of interleukin 6 for neonatal sepsis. QUADAS tools were used for quality evaluation of the studies. A Meta analysis was performed by employing Meta Disc 1.4 and Stata11.0 software. Heterogeneity of the included articles was tested to select proper efficacy model for calculating pooled weighted sensitivity, specificity and 95%CI. Summary receiver operating characteristic (SROC) curve was made and the area under the curve and Q(*) index were calculated.

RESULTSA total of 33 studies including 3 135 neonates were enrolled. The sensitivity and specificity of interleukin 6 for the diagnosis of neonatal sepsis were 0.79 (95%CI: 0.76-0.81) and 0.83 (95%CI: 0.81-0.85) respectively. The area under SROC curve of interleukin 6 for the diagnosis of neonatal sepsis was 0.89 and Q(*) index was 0.83. The post-test probability of diagnosing neonatal sepsis indicated by negative interleukin 6 was 5%, while that of positive interleukin 6 was 60%.

CONCLUSIONSInterleukin 6 measurement is useful for the diagnosis of neonatal sepsis with a high sensitivity and specificity.

Humans ; Infant, Newborn ; Interleukin-6 ; blood ; ROC Curve ; Sensitivity and Specificity ; Sepsis ; diagnosis ; immunology

Blood stream infection (BSI),a blood-borne disease caused by microorganisms such as bacteria,fungi,and viruses,can lead to bacteremia,sepsis,and infectious shock,posing a serious threat to human life and health.Identifying the pathogen is central to the precise treatment of BSI.Traditional blood culture is the gold standard for pathogen identification,while it has limitations in clinical practice due to the long time consumption,production of false negative results,etc.Nanopore sequencing,as a new generation of sequencing technology,can rapidly detect pathogens,drug resistance genes,and virulence genes for the optimization of clinical treatment.This paper reviews the current status of nanopore sequencing technology in the diagnosis of BSI.
Humans ; Nanopore Sequencing ; Sepsis/diagnosis* ; Bacteremia/microbiology* ; Bacteria ; Blood Culture/methods*

PURPOSE: Sepsis is a major cause of neonatal morbidity and mortality. Early diagnosis is a major problem because of the lack of specific clinical signs. Therefore, a reliable diagnostic marker is needed to guide the use of antimicrobial agents. The objective of our study was to assess the value of proadrenomedullin (pro-ADM) in establishing the diagnosis and evaluating the prognosis of neonatal sepsis. METHODS: This study enrolled 60 newborn infants with sepsis proven with positive blood cultures and 30 healthy neonates. Complete blood count, C-reactive protein levels, and pro-ADM levels were obtained from all neonates. RESULTS: The pro-ADM levels were significantly higher (14.39±0.75 nmol/L) in the sepsis group than in the control group (3.12±0.23 nmol/L). The optimal cutoff value for pro-ADM was 4.3 nmol/L, with a sensitivity of 93.3% and a specificity of 86.7%. The pro-ADM levels were also higher in nonsurvivors (P=0.001). CONCLUSION: Pro-ADM can be used as a reliable biomarker for neonatal sepsis. High pro-ADM levels were associated with mortality and could be an early indicator of disease outcome.
Anti-Infective Agents ; Blood Cell Count ; C-Reactive Protein ; Diagnosis ; Early Diagnosis ; Humans ; Infant, Newborn ; Mortality ; Prognosis ; Sensitivity and Specificity ; Sepsis*

BACKGROUND: Bloodstream infection (BSI) is associated with a high mortality rate. Since the origin of infection is demonstrated in approximately 2/3rds of cases, early and established biomarkers are warranted. We evaluated the clinical performances of automated procalcitonin (PCT) and C-reactive protein (CRP) assays for the quantitative detection of BSI. Analytical performance of the VIDAS(R) B.R.A.H.M.S PCT assay (bioMerieux, France) was assessed and also compared with the semi-quantitative PCT-Q test (B.R.A.H.M.S Aktiengesellschaft, Germany). METHODS: We prospectively included consecutive patients divided into 3 groups at the Dong-A University Medical Center. Patients were categorized according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference (ACCP/SCCM), and also on the basis of catheter-associated bacteremia. RESULTS: A total 77 patients were enrolled. All mean values of PCT and PCT-Q were consistent with the reference value. Measured PCT concentrations showed good linearity (r=0.983). The between-run, within-run, and total imprecisions were below 5%. The PCT levels in gram-negative bacteremia were significantly higher than those in gram-positive bacteremia. Furthermore, the PCT concentrations were significantly different among non-infection, bacteremia, sepsis, severe sepsis, and septic shock groups. Our study showed that PCT >0.3 ng/mL had 95.0% sensitivity and 97.3% specificity, whereas CRP >5.46 mg/dL had 85.0% sensitivity and 86.5% specificity for diagnosing sepsis. CONCLUSIONS: We suggest that, compared with CRP, PCT is a better diagnostic and discriminative biomarker of sepsis categorized according to the ACCP/SCCM. Moreover, catheter-associated bacteremia could be discriminated from sepsis using PCT concentration.
Adult ; Bacteremia/*diagnosis ; Biological Markers/analysis/blood ; C-Reactive Protein/analysis ; Calcitonin/*blood ; Female ; Humans ; Male ; Middle Aged ; Protein Precursors/*blood ; ROC Curve ; Sensitivity and Specificity ; Sepsis/diagnosis

Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Pneumonia ; blood ; complications ; diagnosis ; Prognosis ; Retrospective Studies ; Sepsis ; blood ; complications ; diagnosis ; Tumor Necrosis Factor-alpha ; blood