Tehran University Medical Journal

Background: Sepsis is a leading cause of death in infants and children. In this study, we determined sepsis risk factors in children admitted in Bahrami Hospital.

Methods: Medical records of 94 patients with septicemia and a positive blood culture were reviewed in this study. The patients had been admitted during 2010-2011 in different wards of Bahrami Pediatric Hospital. Variables including age, gender, underlying diseases, causative agents and use of medical devices were extracted from the medical records and analyzed statistically.

Results: 54.3% of the cases were male and 51% were below 1 year of age. 54.3% had underlying diseases including malignancy (18.1%) and renal disease (11.7%), which were the most common causes. Failure to thrive (FTT) was detected in 34% of the cases. 82% of the causative bacterial agents were gram positive bacteria and the most common organisms were coagulase negative staphylococci (63.8%) and staphylococcus aureus (10.6%). IV-catheters (100%), NG tubes (9.6%), urinary catheters (4.3%) had been used in the patients. The mortality rate was 6.3%.

Conclusion: This study showed that septicemia was more prevalent in infants and the most common underlying diseases were malignancy and renal disease, respectively. Gram positive bacteria were the most common cause of septicemia.

Background: Bloodstream infections (BSI) have a high incidence and high mortality in the worldwide. The mortality rate is variable between 20-70%. Therefore, early and timely detection of BSI agent in clinical laboratories is necessary. The aim of this study was to determine an efficient diagnostic tool to septicemia in accompany of blood culture method by Real-time PCR (using panbacterial 23S rRNA gene).

Methods: This cross-sectional study was conducted in two analytical and clinical stages in Hamadan University of Medical Sciences, Iran, from October 2014 to June 2015. In analytical stage, sensitivity (by serial dilution from 104 to 1 CFU/ml) and specificity of the primer were evaluated with the Staphylococcus aureus (as Gram positive indicator bacteria) and Escherichia coli (as Gram-negative indicator bacteria), human genome (from Hella cell culture), Candida albicans yeast and Aspergillus fumigatus fungus. In clinical stage, 121 blood samples were collected from patients suspected to sepsis in intensive care unit (ICU) from Hamadan University Hospitals. Finally, the results of Real-time PCR and blood culture methods were compared.

Results: The Real-time PCR showed a sensitivity ranging from 2 to 10 target copies per reaction to the whole blood for Escherichia coli and Staphylococcus aureus respectively. The specificity of this method was evaluated and no false positive amplification was identified. 57.85% (70 cases) of the samples were positive by Real-time PCR and 13.22% (16 cases) of the samples were positive by blood culture. However, none of the cases that were positive by blood culture were negative in Real-time PCR. As well as, 44.62% (54 cases) of cases were positive by Real-time PCR but blood culture showed no bacteria in the samples, and 42.15% (51 cases) were negative by both methods. Correlation or agreement of Kappa was 0.20, that indicating poor agreement between the two methods.

Conclusion: Real-time PCR is more sensitive than blood culture and also, because of high sensitivity of this primer by Real-time PCR, we can use it for screening blood samples from suspected patients of sepsis.