Title : Role of serial blood cultures 24 hours in the evaluation of suspected neonatal sepsis
Abstract:
Background: Neonatal sepsis is a significant cause of morbidity and mortality in low- and middle-income countries. Timely and accurate diagnosis of neonatal sepsis continues to be a major clinical challenge. The study aims to determine whether sequential cultures improve pathogen detection and aid in differentiating true bacteraemia from contamination, thereby supporting more rational and targeted antimicrobial therapy.
Methods: This prospective cohort study assessed the diagnostic yield of sequential blood culture. All admitted neonates who were initiated on antibiotics for suspected neonatal sepsis were included. The first blood culture was collected prior to antibiotic administration. Antibiotic selection and management were entirely at the discretion of the treating physicians. A second blood culture was collected 24 hours after the first sample.
Results: Among 399 suspected neonatal sepsis episodes, the first blood culture was positive in 55 (13.78%). In the second blood culture after 24 hours, additional pathogens were detected in 13 cases (3.25%). 4 contaminants in the first blood culture were reclassified as pathogens, 6 contaminated first cultures were confirmed as true contaminations. Following a second blood culture at 24 hours, the overall culture positivity increased to 72 cases (18.04%), representing a 30.91% relative increase over the initial yield. Serial blood cultures have improved microbiological clarity in neonatal sepsis.
Conclusion: Serial blood cultures obtained 24 hours apart enhance diagnostic yield in neonates with suspected sepsis by increasing cumulative culture positivity and enabling clearer differentiation between true bacteremia and contamination.
Keywords: Neonatal sepsis, Blood culture, Diagnostic yield
