The diagnosis of sepsis remains one of the most difficult tasks for
physicians and other medical staff. Blood cultures often remain
negative in the presence of pneumonia, meningitis and even fulminant
blood born septicemia. A rapid laboratory test with high specificity for
neonatal sepsis would be a valuable tool in therapeutic decision
making and avoiding the unnecessary use of antibiotics in patients
with clinical signs and symptoms of sepsis but negative blood
cultures. The rapid upregulation of CD64 expression on the
polymorphnuclear neutrophils (PMNs) and the normal 6-hour half-life
of the blood PMNs made the determination of the PMN CD64
expression a true indication of the current status of neonatal sepsis. In
this study, we selected the CD64 to detect its value in the diagnosis of
early-onset neonatal sepsis cases by using the flow cytometry. We
aimed to evaluate its association with the different demographic,
clinical and laboratory data. The current study was carried out on 100
patients; 40 diagnosed early onset neonatal sepsis (EONS) (culture +
ve) neonates, 40 clinically suspected EONS (culture -ve) and 20
neonates (healthy or admitted for jaundice) as a control group. All
patients were subjected to complete history taking, thorough clinical
examination and laboratory investigations. We found that; CD 64
expression was only positive in both EONS groups but not in control
group. CD64 expression was significantly higher in EONS (culture
+ve) group than in suspected EONS (culture -ve). It has high
sensitivity (80%) and intermediate +ve predictive value (53%), but
low specificity (10%). We found that CD64 expression had no
correlation to any of the clinical or laboratory findings except for the
temperature and CRP. when we used the ROC curve to compare the
area under the curve between the CD64 & CRP we found that the area
under the curve (accuracy) for CD64 =0.855, while area under the
curve (accuracy) for CRP =0.493. This implies the greater diagnostic
power for CD64 than CRP for early detection of EONS. |
