Diagnostic Accuracy of Endotoxin and Endotoxin Binding Protein in Late-Onset Neonatal Sepsis

OBJECTIVES

To evaluate the diagnostic utility of endotoxin and endotoxin binding protein (EBP) for the diagnosis of late-onset neonatal sepsis (LOS) and compare it with the diagnostic utility of C-reactive protein (CRP).

METHODS

This diagnostic study of neonates, both term and preterm, with clinical suspicion of LOS was conducted in a tertiary care institute in India between January 2021 and March 2023. Blood samples were collected for evaluating endotoxin and EBP along with culture. Endotoxin and EBP were measured with enzyme linked immunosorbent assay, CRP was measured by nephelometry method, and the results were compared with blood culture done with BACTEC (gold standard).

RESULTS

Out of 160 samples, 73 showed culture positivity. Endotoxin was positive in 81 samples and showed sensitivity of 84%, specificity of 78% and diagnostic accuracy of 81% (AUC 0.837, P value <0.001). EBP was positive in 82 samples and showed sensitivity of 80.8%, specificity of 73% and diagnostic accuracy of 76% (AUC 0.824, P value <0.001). CRP was positive in 105 samples and had sensitivity of 86%, specificity of 51% and diagnostic accuracy of 67% (AUC 0.827, P value <0.001).

CONCLUSIONS

The present study showed endotoxin and EBP have higher specificity for diagnosing neonatal sepsis. As culture takes minimum 48 h, endotoxin and EBP can be utilized as biomarkers for diagnosis of sepsis.

Effectiveness of Minocycline in Multidrug Resistance Gram Negative Bacilli: A Cross-sectional Study

Introduction: Antibiotic resistance is a global public health threat and remains a challenge for the physicians. Due to increased incidence of resistance to the commonly prescribed antibiotics, a newer drug or a re-emerge of an older class of antibiotic will be a choice of treatment of the Multidrug Resistant (MDR) organisms. Aim: To determine the effectiveness of Minocycline in MDR gram negative bacterial isolates by determining its Minimum Inhibitory Concentration (MIC) and to compare its effectiveness with Imipenem and Meropenem. Materials and Methods: A cross-sectional periodical study was conducted during May 2016 to May 2017 using 150 non repetitive MDR gram negative bacterial isolates recovered from various clinical specimens sent to Central Laboratory, Department of Microbiology, Sri Ramachandra Medical College & Research Institute, SRIHER, Porur, Chennai, India. All the isolates were subjected for antibiotic susceptibility testing by disc diffusion method for the routine antibiotics and MIC determination by Epsilometry test (E-Strip) for Minocycline and Meropenem and interpreted as per Clinical and Laboratory Standards Institute (CLSI) guidelines 2016. Results: Out of the 150 study isolates minocycline was was susceptible in 105 (70%; n=150) followed by imipenem and meropenem both susceptible for 94 isolates (62.7%; n=150). Minocycline was also susceptible among the 84% (79; n=94) of meropenem susceptible strains with a statistically significant p-value of <0.05. Similarly 46.4% (26; n=56) of meropenem resistant strains were susceptible for minocycline which was also statistically significant with a p-value <0.05. Conclusion: Considering the cost of treatment with colistin which is the choice of treatment for carbapenemase producing gram negative bacteria’s, minocycline can be considered as it is cheaper and less toxic. The possibility to switch from injectable to oral formulation is also possible with minocycline and so can also be considered as an alternative for colistin in such conditions.