DIAGNOSING NEONATAL SEPSIS USING MOLECULAR TECHNIQUES

高危新生儿的预防性抗生素治疗 全身性感染(败血症)发生在大量出生于 美国的这种疗法增加了婴儿的住院时间， 新生儿暂时与他们的母亲分离，并使婴儿暴露 到日益昂贵和过度使用的抗生素。如果一个 婴儿生病，这样的干预措施是合理的；新生儿败血症 是危及生命的紧急医疗事件。然而，很有可能 超过85%的这类婴儿没有感染。迅速， 目标是准确检测15%-20%的受感染婴儿 这项提议。为此，我们将确定DNA的用途- 一种直接检测细菌或酵母DNA的扩增方法 从正在接受败血症评估的新生儿身上获得的血液样本。 目前的护理标准是血液培养，但这种方法缺乏 敏感度，需要大于或等于12小时到2天 检测生物体。这些问题现在进一步恶化，因为更多 接受产中抗生素治疗的母亲所生的婴儿 B群链球菌定植。尽管抗生素治疗对 这些女性降低了新生儿GBS败血症的发生率、风险 还没有完全消除，它实际上可能会破坏 获得高质量血培养结果的机会。这是因为 产中治疗后婴儿血液中的抗生素可能会 减少可培养生物的回收，如果存在，使阴性 培养结果不能排除脓毒症。这将创建一个 婴儿不必要地使用抗生素治疗的情况。 在玛吉妇女医院，大约1300名新生儿接受了评估 每年都有败血症。在大多数情况下(87%)，血液 培养是无菌的。尽管如此，婴儿仍被给予抗生素 大于或等于48小时。一种更敏感、更可靠的方法 排除脓毒症将显著减少健康人群的预防 婴儿。如果这种已知只需8小时的新化验 比培养更可靠，这将导致巨大的成本 节省；减少住院天数，不必要的抗生素暴露和 产生抗药性的风险。除了这些有形的 好处，就会有减轻情感负担的好处 母亲们必须带着她们健康的新生命离开医院 出生的婴儿，并消除如何继续乳房的并发症 如果母婴分开，就要喂奶。

Preventive antibiotic therapy of newborn human infants at risk for systemic infection (sepsis) occurs in large numbers of infants born in the U.S. Such therapy increases hospitalization stay for infants, temporary separation of newborns from their mothers, and exposes infants to antibiotics which are increasingly expensive and overused. If an infant is ill, such interventions are well justified; neonatal sepsis is a life threatening medical emergency. However, it is quite possible that greater than 85 percent of such infants are not infected. Rapid, accurate detection of the 15-20 percent of infected infants is the goal of this proposal. To this end, we will determine the utility of a DNA- based amplification assay for detecting bacterial or yeast DNA directly from blood samples obtained from neonates being evaluated for sepsis. The current standard of care is blood culture, but this method lacks sensitivity, and requires greater than or equal to 12 hr to 2 days to detect organisms. These problems are exacerbated further now that more infants are being born to mothers receiving intrapartum antibiotics for Group B Streptococcus colonization. Although antibiotic therapy for these women has decreased the incidence of neonatal GBS sepsis, the risk has not been eliminated completely, and it may actually undermine the chance of obtaining high quality blood culture results. This is because antibiotics within the infants' blood from intrapartum therapy may reduce recovery of culturable organisms, if present, making a negative culture result unreliable for ruling out sepsis. This creates a situation in which infants are unnecessarily treated with antibiotics. At Magee-Womens Hospital, approximately 1300 neonates are evaluated for sepsis annually. In the majority of cases (87 percent), the blood cultures are sterile. Despite this fact, infants are given antibiotics for greater than or equal to 48 hr. A more sensitive, reliable method of ruling out sepsis would markedly reduce prophylaxis of healthy infants. If this new assay, which is already known to take only 8 hr is more reliable than culture, it will result in a significant cost savings; reduction in hospital days, unnecessary antibiotic exposure and risk of developing drug resistance. In addition to these tangible benefits, there will be the benefit of reducing the emotional burden to mothers who must otherwise leave the hospital without their healthy new born infants, and eliminate the complication of how to continue breast feeding if the mother/infant pair is separated.