CD64 and CD11b Versus Conventional Bacteriological Methods in Early Detection of Bacterial Neonatal Sepsis

Abstract
Background: Neonatal sepsis is a life-threatening disease that remains a major cause of morbidity and mortality in the newborn. Early recognition and implementation of appropriate therapy offers the best outcome, and careful assessment of the newborn is essential. Early-onset sepsis (EOS) presents a fulminant multi-system illness during the first days of life. Early detection of neonatal sepsis is difficult as the clinical signs are non-specific and indistinguishable from those caused by a variety of neonatal non-infective disorders such as aspiration syndrome and respiratory distress syndrome. An important early event in sepsis is the generation and release of cytokines by immune cells in response to invasion by bacteria and their toxins. Flow cytometry analysis of cell surface antigens (CD64, CD11b, CD32, CD16, CD69, CD25, and CD45) have been performed to detect neonatal sepsis.
Aim of Study: To evaluate the usefulness of estimation of neutrophil expression of CD64 and CD1 1b in bacterial neonatal sepsis and to investigate possible relationship between their levels, other markers of sepsis as total leucocytec count (TLC), platelet count and C Reactive protein (CRP), whether levels of expressed CD64 and CD11b correlated with severity of illness, survival or not and to investigate the possible relation between CD64 and CD11b.
Patients and Methods: All Newborns were subjected to complete blood count (CBC), CRP, blood cultures and flow-cytometry analysis that had been done for detection of CD 64, CD11b on neutrophils.
Results: All prospective study enrolled newborns docu-mented sepsis group (n=40) and control newborn group (n=40). It was found that the blood cultures in sepsis group demon-strated the presence of E.coli, KlebsiellaPneumoniae, Staphau-reus, Staph Hominis, Staph lentus and Pseudomonas aerog-enosa. Also, the mean levels of CD64 and CD11b in sepsis group were significantly higher than that in healthy group p value is 0.001. ROC analysis showed that both CD64 and CD1 1b could be used for early detection of sepsis with sensitivity and specificity of more than 97%.
Conclusion: The expression of the neutrophil activation markers CD11b and CD64 could be a reliable tool for early prediction and diagnostic of early detection of bacterial neonatal sepsis in the suspected presence neonate, irrespective to otherlaboratory results and before the evolution of clinical signs. Thus, they might indicate the necessity of early initiation of antibiotic treatment for sepsis, with corresponding improve-ment of the outcome, and reduce the unnecessary use of antimicrobials in non-infected neonates, without waiting for definitive microbiologic results.