Neonatal sepsis: looking beyond the blood culture: evaluation of a study of universal primer polymerase chain reaction for identification of neonatal sepsis.

D IFFERENTIATING BACTERIAL SEPSIS FROM other conditions common in infants in the neonatal intensive care unit poses a number of challenges. First, clinical signs such as apnea, feeding intolerance, and need for increased respiratory support are nonspecific but still of concern for bacterial sepsis. These signs often prompt evaluation for sepsis that includes blood culture and antibiotic therapy for up to 48 hours while awaiting blood culture results. Second, blood culture accuracy may be decreased in neonates exposed to antibiotic agents during labor. Third, in some instances, a blood culture cannot be obtained before the initiation of antibiotic therapy. A test that could enable quick and accurate diagnosis of bacterial sepsis in these situations could avert unnecessary antibiotic therapy. To date, others tests such as white blood cell count, absolute neutrophil count, and C-reactive protein (CRP) level have not proved sufficiently accurate to justify withholding initial antibiotic therapy. In addition, no available test can enable accurate diagnosis of bacterial sepsis in neonates exposed to antibiotic agents before collection of blood for culture. Universal primer polymerase chain reaction (PCR) has been suggested as a potentially useful test in the diagnosis of neonatal sepsis in these settings.