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January 8, 1988, Vol 259, No. 2 >
ARTICLE | January 8, 1988

Sensitivity, Specificity, and Predictive Value of Body Surface Cultures in a Neonatal Intensive Care Unit FREE

Martin E. Evans, MD; William Schaffner, MD; Charles F. Federspiel, PhD; Robert B. Cotton, MD; Kelly T. McKee, Jr, MD; Charles W. Stratton, MD
[+] Author Affiliations

Reprint requests to Department of Pathology, Vanderbilt University School of Medicine, Nashville, TN 37232 (Dr Stratton).


JAMA. 1988;259(2):248-252. doi:10.1001/jama.1988.03720020050036
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References

We analyzed 24 584 cultures obtained from 3371 infants during a three-year period to determine how frequently body surface culture isolates matched those obtained subsequently from body fluids. The sensitivity, specificity, and predictive values of surface cultures were calculated daily for the two weeks up to and including the day that a body fluid culture was obtained. Isolates from cultures of material from the ear canal, nasopharynx, axilla, umbilicus, groin, rectum, stomach, and endotracheal tube were rarely the same as those recovered from blood or fluids of the cerebrospinal, joint, pleural, pericardial, and peritoneal spaces. With a frequency of sepsis of 3.3% among patients in our neonatal intensive care unit, the optimum sensitivity, specificity, and positive predictive values of surface cultures were 56%, 82%, and 7.5%, respectively. These values did not improve substantially for any specific times of surface cultures prior to sepsis, for anatomic sites cultured, or for pathogens recovered. We conclude that surface cultures are of limited value in predicting the etiology of sepsis in neonates.

(JAMA 1988;259:248-252)

REFERENCES

1 +
White RD, Townsend TR, Stephens MA, et al:  Are surveillance of resistant enteric bacilli and antimicrobial usage among neonates in a newborn intensive care unit useful? Pediatrics 1981;;68:1-4.
2 +
Goldmann DA:  Bacterial colonization and infection in the neonate. Am J Med 1981;;70:417-422.
3 +
Hemming VG, Overall JC, Britt MR:  Nosocomial infections in a newborn intensive-care unit: Results of 41 months of surveillance. N Engl J Med 1976;;294:1310-1316.
4 +
Goldmann DA, Leclair J, Macone A:  Bacterial colonization of neonates admitted to an intensive care environment. J Pediatr 1978;;93:288-292.
5 +
Simon HJ, Yaffe SJ, Gluck L:  Effective control of staphylococci in a nursery. N Engl J Med 1961;;265:1171-1176.
6 +
Coventry KJ, Isbister C:  A bacteriological and clinical study of infection in newborn babies in a maternity hospital nursery. Med J Aust 1951;;2:394-396.
7 +
Griner PF, Mayewski RJ, Mushlin AI, et al:  Selection and interpretation of diagnostic tests and procedures: Principles and applications. Ann Intern Med 1981;;94:553-600.
8 +
 Residencies and fellowships in pediatric subspecialties and general academic pediatric training, abstracted. J Pediatr 1981;;99:45-83.
9 +
Echeverria P:  Observations concerning infections with beta-hemolytic streptococci, not group A or B, in neonates. J Pediatr 1973;;83:499-500.
10 +
Ablow RC, Driscoll SG, Effmann EL, et al:  A comparison of early-onset group B streptococcal neonatal infection and the respiratory-distress syndrome of the newborn. N Engl J Med 1976;;294:65-70.
11 +
Boyle RJ, Chandler BD, Stonestreet BS, et al:  Early identification of sepsis in infants with respiratory distress. Pediatrics 1978;;62:744-750.
12 +
Ramos A, Stern L:  Relationship of premature rupture of the membranes to gastric fluid aspirate in the newborn. Am J Obstet Gynecol 1969;;105: 1247-1251.
13 +
Scanlon J:  The early detection of neonatal sepsis by examination of liquid obtained from the external ear canal. J Pediatr 1971;;79:247-249.
14 +
Sprunt K, Leidy G, Redman W:  Abnormal colonization of neonates in an intensive care unit: Means of identifying neonates at risk of infection. Pediatr Res 1978;;12:998-1002.
15 +
Sprunt K, Redman W, Leidy G:  Contribution of antibiotic therapy to increased risk of infection in intensive care unit neonates , in Nelson JD, Grassi C (eds): Current Chemotherapy of Infectious Diseases . Washington, DC, American Society for Microbiology, 1980;, pp 1181-1183.
16 +
Sprunt K:  Practical use of surveillance for prevention of nosocomial infection. Semin Perinatol 1985;;9:47-50.
17 +
MacGregor RR, Tunnessen WW:  The incidence of pathogenic organisms in the normal flora of the neonate's external ear and nasopharynx. Clin Pediatr 1973;;12:697-700.
18 +
Mims LC, Medwar MS, Perkins JR, et al:  Predicting neonatal infections by evaluation of the gastric aspirate: A study in 207 patients. Am J Obstet Gynecol 1972;;114:232-238.
19 +
Merenstein GB, Koziol DF, Brown GL, et al:  Radiant warmers versus incubators for neonatal care. AJDC 1979;;133:857-858.
20 +
Townsend TR, Wenzel RP:  Nosocomial blood-stream infections in a newborn intensive care unit: A case-matched control study of morbidity, mortality and risk. Am J Epidemiol 1981;;114:73-80.
21 +
McKee KT Jr, Cotton RB, Stratton CW, et al:  Nursery epidemic due to multiply-resistant Klebsiella pneumoniae: Epidemiologic setting and impact on perinatal health care delivery. Infect Control 1981;;3:150-156.
22 +
Siegel J:  Controlling infections in the nursery. Pediatr Infect Dis 1985;;4:536-541.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
White RD, Townsend TR, Stephens MA, et al:  Are surveillance of resistant enteric bacilli and antimicrobial usage among neonates in a newborn intensive care unit useful? Pediatrics 1981;;68:1-4.
2 +
Goldmann DA:  Bacterial colonization and infection in the neonate. Am J Med 1981;;70:417-422.
3 +
Hemming VG, Overall JC, Britt MR:  Nosocomial infections in a newborn intensive-care unit: Results of 41 months of surveillance. N Engl J Med 1976;;294:1310-1316.
4 +
Goldmann DA, Leclair J, Macone A:  Bacterial colonization of neonates admitted to an intensive care environment. J Pediatr 1978;;93:288-292.
5 +
Simon HJ, Yaffe SJ, Gluck L:  Effective control of staphylococci in a nursery. N Engl J Med 1961;;265:1171-1176.
6 +
Coventry KJ, Isbister C:  A bacteriological and clinical study of infection in newborn babies in a maternity hospital nursery. Med J Aust 1951;;2:394-396.
7 +
Griner PF, Mayewski RJ, Mushlin AI, et al:  Selection and interpretation of diagnostic tests and procedures: Principles and applications. Ann Intern Med 1981;;94:553-600.
8 +
 Residencies and fellowships in pediatric subspecialties and general academic pediatric training, abstracted. J Pediatr 1981;;99:45-83.
9 +
Echeverria P:  Observations concerning infections with beta-hemolytic streptococci, not group A or B, in neonates. J Pediatr 1973;;83:499-500.
10 +
Ablow RC, Driscoll SG, Effmann EL, et al:  A comparison of early-onset group B streptococcal neonatal infection and the respiratory-distress syndrome of the newborn. N Engl J Med 1976;;294:65-70.
11 +
Boyle RJ, Chandler BD, Stonestreet BS, et al:  Early identification of sepsis in infants with respiratory distress. Pediatrics 1978;;62:744-750.
12 +
Ramos A, Stern L:  Relationship of premature rupture of the membranes to gastric fluid aspirate in the newborn. Am J Obstet Gynecol 1969;;105: 1247-1251.
13 +
Scanlon J:  The early detection of neonatal sepsis by examination of liquid obtained from the external ear canal. J Pediatr 1971;;79:247-249.
14 +
Sprunt K, Leidy G, Redman W:  Abnormal colonization of neonates in an intensive care unit: Means of identifying neonates at risk of infection. Pediatr Res 1978;;12:998-1002.
15 +
Sprunt K, Redman W, Leidy G:  Contribution of antibiotic therapy to increased risk of infection in intensive care unit neonates , in Nelson JD, Grassi C (eds): Current Chemotherapy of Infectious Diseases . Washington, DC, American Society for Microbiology, 1980;, pp 1181-1183.
16 +
Sprunt K:  Practical use of surveillance for prevention of nosocomial infection. Semin Perinatol 1985;;9:47-50.
17 +
MacGregor RR, Tunnessen WW:  The incidence of pathogenic organisms in the normal flora of the neonate's external ear and nasopharynx. Clin Pediatr 1973;;12:697-700.
18 +
Mims LC, Medwar MS, Perkins JR, et al:  Predicting neonatal infections by evaluation of the gastric aspirate: A study in 207 patients. Am J Obstet Gynecol 1972;;114:232-238.
19 +
Merenstein GB, Koziol DF, Brown GL, et al:  Radiant warmers versus incubators for neonatal care. AJDC 1979;;133:857-858.
20 +
Townsend TR, Wenzel RP:  Nosocomial blood-stream infections in a newborn intensive care unit: A case-matched control study of morbidity, mortality and risk. Am J Epidemiol 1981;;114:73-80.
21 +
McKee KT Jr, Cotton RB, Stratton CW, et al:  Nursery epidemic due to multiply-resistant Klebsiella pneumoniae: Epidemiologic setting and impact on perinatal health care delivery. Infect Control 1981;;3:150-156.
22 +
Siegel J:  Controlling infections in the nursery. Pediatr Infect Dis 1985;;4:536-541.

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