Clinical and laboratorial parameters related to the diagnosis of late onset neonatal sepsis laboratory-confirmed associated with central venous catheter in newborns in a reference neonatal unit

Resumo

Background and Objectives: To evaluate clinical and laboratorial variables associated with diagnosis of laboratory-confirmed sepsis associated with central venous catheter (CVC) in newborns.

Methods: Prospective cohort study carried out in a reference neonatal unit from 2015 to 2017. Newborns using CVC were included and informations were obtained from medical records. The outcome was considered an episode of laboratory-confirmed sepsis associated with CVC for evaluation of clinical and laboratorial variables. The SPSS version 20.0 program was utilized for statistical analysis. The study was approved by the ethics committee of institution.

Results: A total of 191 newborns with CVC were identified, which 92 have had 95 episodes of suspected sepsis. Only 33 of them were considered laboratory-confirmed episodes of sepsis by the National Health Surveillance Agency of Brazil criteria, and 20 were considered laboratory-confirmed episodes of sepsis by the Centers for Disease Control and Prevention criteria. The immature/total segmented ratio (I/T ratio) was statistically significant in univariate and multivariate model as an independent variable associated with laboratory-confirmed sepsis associated with CVC (p=0.009). In cases confirmed by international criteria, hypothermia and hyperthermia remained as clinically significant changes in laboratory-confirmed CVC-associated sepsis in  multivariate analysis.

Conclusion: Higher immature/total neutrophils ratio, increased C-reactive protein and thermal instability are parameters that help in defining CVC-associated sepsis and may contribute to the decision on rational use of antimicrobials, considering the low sensitivity of blood cultures and isolation of skin contaminants in a single sample.