Optimizing resource utilization in low- and middle-income country NICUs: A clinical audit of surgical infection screening practices at a high-volume NICU in Pakistan

Document Type

Article

Department

Medical College Pakistan; Surgery

Abstract

Objective: Post operative sepsis in neonates is a serious problem that may be challenging to diagnose. It is standard practice at our Neonatal Intensive Care Unit (NICU) in Pakistan to perform routine Blood Cultures (BLCS) and C-Reactive Protein (CRP) to screen for post-operative sepsis. We aimed to review this practice to investigate its effectiveness at screening for post-operative sepsis.
Methodology: All neonates admitted to the NICU post-operatively at our center from 2017-2022 were included. Relevant clinical and demographic data were collected. The sensitivity of BLCS was calculated for each post-operative day (POD) and an ROC curve was constructed for overall CRP values to quantify their screening value.
Results: A total of 109 post-operative neonates were included (median gestational age 37 weeks, birth weight 2.4kg). Thirteen (12.6%) developed sepsis. Only two patients had pathological microbe growth on POD 0 or 1, both having growth preoperatively. BLCS sensitivity increased significantly after POD 2. CRP performed poorly at discriminating post-operative sepsis (AUROC=0.55).
Conclusion: Routine BLCS performed immediately after surgery did not predict the onset of post-operative sepsis. CRP performed poorly at discriminating post-operative sepsis, likely due to physiologic inflammation in post-operative neonates. Unnecessary screening tests represent a significant financial burden in LMICs, with little clear clinical benefit.

Publication (Name of Journal)

Pakistan Journal of Medical Sciences

DOI

10.12669/pjms.42.(11AASC).15734

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