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International Journal of Pediatrics
Volume 2012 (2012), Article ID 120139, 14 pages
doi:10.1155/2012/120139
Review Article

How Can the Microbiologist Help in Diagnosing Neonatal Sepsis?

Michela Paolucci, Maria Paola Landini, and Vittorio Sambri

Unit of Microbiology, Department of Haematology and Oncology “L. e A. Seràgnoli”, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy

Received 23 June 2011; Revised 15 September 2011; Accepted 29 November 2011

Academic Editor: Paul T. Heath

Copyright © 2012 Michela Paolucci et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. M. Singh, “Perinatal infections,” in Care of the Newborn, M. Singh, Ed., pp. 198–221, New Delhi, India, 5th edition, 1999.
  2. B. Chacko and I. Sohi, “Early onset neonatal sepsis,” Indian Journal of Pediatrics, vol. 72, no. 1, pp. 23–26, 2005. View at Scopus
  3. G. Klinger, I. Levy, L. Sirota, V. Boyko, B. Reichman, and L. Lerner-Geva, “Epidemiology and risk factors for early onset sepsis among very-low-birthweight infants,” American Journal of Obstetrics and Gynecology, vol. 201, no. 1, pp. 38.e1–38.e6, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  4. N. Jean-Baptiste, D. K. Benjamin Jr., M. Cohen-Wolkowiez, et al., “Coagulase-negative staphylococcal infections in the neonatal intensive care unit,” Infection Control and Hospital Epidemiology, vol. 32, no. 7, pp. 679–686, 2011. View at Publisher · View at Google Scholar · View at PubMed
  5. J. A. Regan, M. A. Klebanoff, R. P. Nugent et al., “Colonization with group B streptococci in pregnancy and adverse outcome,” American Journal of Obstetrics and Gynecology, vol. 174, no. 4, pp. 1354–1360, 1996. View at Publisher · View at Google Scholar
  6. CDC, “Trends in perinatal group B streptococcal disease—United States, 2000–2006,” Morbidity and Mortality Weekly Report, vol. 58, no. 5, pp. 109–112, 2009.
  7. C. R. Phares, R. Lynfield, M. M. Farley et al., “Epidemiology of invasive group B streptococcal disease in the United States, 1999–2005,” Journal of the American Medical Association, vol. 299, no. 17, pp. 2056–2065, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  8. V. Nizet, P. Ferrieri, and C. E. Rubens, “Molecular pathogenesis of group B streptococcal disease in newborns,” in Streptococcal Infections: Clinical Aspects, Microbiology, and Molecular Pathogenesis, D. Stevens, Ed., pp. 180–221, Oxford University Press, New York, NY, USA, 2000.
  9. K. M. Boyer, C. A. Gadzala, P. D. Kelly, L. I. Burd, and S. P. Gotoff, “Selective intrapartum chemoprophylaxis of neonatal group B streptococcal early-onset disease. II. Predictive value of prenatal cultures,” Journal of Infectious Diseases, vol. 148, no. 5, pp. 802–809, 1983. View at Scopus
  10. S. Schrag, R. Gorwitz, K. Fultz-Butts, and A. Schuchat, “Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC,” Morbidity and Mortality Weekly Report, vol. 51, no. 11, pp. 1–22, 2002. View at Scopus
  11. M. S. Badri, S. Zawaneh, A. C. Cruz, et al., “Rectal colonization with group B streptococcus: relation to vaginal colonization of pregnant women,” Journal of Infectious Diseases, vol. 135, no. 2, pp. 308–312, 1977.
  12. H. W. Wilkinson, “CAMP-disk test for presumptive identification of group B streptococci,” Journal of Clinical Microbiology, vol. 6, no. 1, pp. 42–45, 1977. View at Scopus
  13. C. Guerrero, J. Martínez, A. Menasalvas, R. Blázquez, T. Rodríguez, and M. Segovia, “Use of direct latex agglutination testing of selective broth in the detection of group B strepptococcal carriage in pregnant women,” European Journal of Clinical Microbiology and Infectious Diseases, vol. 23, no. 1, pp. 61–62, 2004. View at Publisher · View at Google Scholar · View at PubMed
  14. CDC, “Laboratory practices for prenatal group B streptococcal screening and reporting—Connecticut, Georgia, Minnesota, 1997-1998,” Morbidity and Mortality Weekly Report, vol. 48, no. 20, pp. 426–428, 1999.
  15. M. Votava, M. Tejkalová, M. Drábková, V. Unzeitig, and I. Braveny, “Use of GBS media for rapid detection of group B streptococci in vaginal and rectal swabs from women in labor,” European Journal of Clinical Microbiology and Infectious Diseases, vol. 20, no. 2, pp. 120–122, 2001.
  16. A. Tazi, H. Réglier-Poupet, F. Dautezac, J. Raymond, and C. Poyart, “Comparative evaluation of Strepto B ID®chromogenic medium and Granada media for the detection of group B streptococcus from vaginal samples of pregnant women,” Journal of Microbiological Methods, vol. 73, no. 3, pp. 263–265, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  17. C. J. Baker, “Inadequacy of rapid immunoassays for intrapartum detection of group B streptococcal carriers,” Obstetrics and Gynecology, vol. 88, no. 1, pp. 51–55, 1996. View at Publisher · View at Google Scholar · View at Scopus
  18. R. Samadi, A. Stek, and J. S. Greenspoon, “Evaluation of a rapid optical immunoassay-based test for group B streptococcus colonization in intrapartum patients,” Journal of Maternal-Fetal Medicine, vol. 10, no. 3, pp. 203–208, 2001. View at Scopus
  19. D. Kaufman and K. D. Fairchild, “Clinical microbiology of bacterial and fungal sepsis in very-low-birth-weight infants,” Clinical Microbiology Reviews, vol. 17, no. 3, pp. 638–680, 2004, table of contents. View at Publisher · View at Google Scholar · View at PubMed
  20. K. M. Ryan, S. G. Lencki, B. L. Elder, W. I. Northern, H. J. Khamis, and J. A. Bofill, “DNA probe for β-hemolytic group B streptococcus: diagnostic accuracy in threatened preterm labor,” Journal of Reproductive Medicine for the Obstetrician and Gynecologist, vol. 44, no. 7, pp. 587–591, 1999. View at Scopus
  21. N. Williams-Bouyer, B. S. Reisner, and G. L. Woods, “Comparison of gen-probe AccuProbe group B streptococcus culture identification test with conventional culture for the detection of group B streptococci in broth cultures of vaginal-anorectal specimens from pregnant women,” Diagnostic Microbiology and Infectious Disease, vol. 36, no. 3, pp. 159–162, 2000. View at Publisher · View at Google Scholar
  22. N. S. Montague, T. J. Cleary, O. V. Martinez, and G. W. Procop, “Detection of group B streptococci in Lim broth by use of group B streptococcus peptide nucleic acid fluorescent in situ hybridization and selective and nonselective agars,” Journal of Clinical Microbiology, vol. 46, no. 10, pp. 3470–3472, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  23. H. Peltroche-Llacsahuanga, M. J. Fiandaca, S. von Oy, R. Lütticken, and G. Haase, “Rapid detection of streptococcus agalactiae from swabs by peptide nucleic acid fluorescence in situ hybridization,” Journal of Medical Microbiology, vol. 59, no. 2, pp. 179–184, 2010. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  24. J. S. Goodrich and M. B. Miller, “Comparison of culture and 2 real-time polymerase chain reaction assays to detect group B streptococcus during antepartum screening,” Diagnostic Microbiology and Infectious Disease, vol. 59, no. 1, pp. 17–22, 2007. View at Publisher · View at Google Scholar · View at PubMed
  25. T. Block, E. Munson, A. Culver, K. Vaughan, and J. E. Hryciuk, “Comparison of carrot broth-and selective Todd-Hewitt broth-enhanced PCR protocols for real-time detection of streptococcus agalactiae in prenatal vaginal/anorectal specimens,” Journal of Clinical Microbiology, vol. 46, no. 11, pp. 3615–3620, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  26. H. D. Davies, M. A. Miller, S. Faro, D. Gregson, S. C. Kehl, and J. A. Jordan, “Multicenter study of a rapid molecular-based assay for the diagnosis of group B streptococcus colonization in pregnant women,” Clinical Infectious Diseases, vol. 39, no. 8, pp. 1129–1135, 2004. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  27. N. Aziz, E. J. Baron, H. D'Souza, M. Nourbakhsh, M. L. Druzin, and W. E. Benitz, “Comparison of rapid intrapartum screening methods for group B streptococcal vaginal colonization,” Journal of Maternal-Fetal and Neonatal Medicine, vol. 18, no. 4, pp. 225–229, 2005. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  28. K. L. Atkins, R. M. Atkinson, A. Shanks, C. A. Parvin, W. M. Dunne, and G. Gross, “Evaluation of polymerase chain reaction for group B streptococcus detection using an improved culture method,” Obstetrics and Gynecology, vol. 108, no. 3, pp. 488–491, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  29. M. Gavino and E. Wang, “A comparison of a new rapid real-time polymerase chain reaction system to traditional culture in determining group B streptococcus colonization,” American Journal of Obstetrics and Gynecology, vol. 197, no. 4, pp. 388.e1–388.e4, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  30. D. Smith, J. D. Perry, L. Laine, A. Galloway, and F. K. Gould, “Comparison of BD GeneOhm real-time polymerase chain reaction with chromogenic and conventional culture methods for detection of group B streptococcus in clinical samples,” Diagnostic Microbiology and Infectious Disease, vol. 61, no. 4, pp. 369–372, 2008. View at Publisher · View at Google Scholar · View at PubMed
  31. R. K. Edwards, S. M. Novak-Weekley, P. P. Koty, T. Davis, L. J. Leeds, and J. A. Jordan, “Rapid group B streptococci screening using a real-time polymerase chain reaction assay,” Obstetrics and Gynecology, vol. 111, no. 6, pp. 1335–1341, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  32. D. Money, S. Dobson, L. Cole et al., “An evaluation of a rapid real time polymerase chain reaction assay for detection of group B streptococcus as part of a neonatal group B streptococcus prevention strategy,” Journal of Obstetrics and Gynaecology Canada, vol. 30, no. 9, pp. 770–775, 2008. View at Scopus
  33. N. E. Helali, J. C. Nguyen, A. Ly, Y. Giovangrandi, and L. Trinquart, “Diagnostic accuracy of a rapid real-time polymerase chain reaction assay for universal intrapartum group b streptococcus screening,” Clinical Infectious Diseases, vol. 49, no. 3, pp. 417–423, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  34. M. J. Alfa, S. Sepehri, P. de Gagne, M. Helawa, G. Sandhu, and G. K. M. Harding, “Real-time PCR assay provides reliable assessment of intrapartum carriage of group B streptococcus,” Journal of Clinical Microbiology, vol. 48, no. 9, pp. 3095–3099, 2010. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  35. L. M. Scicchitano and P. P. Bourbeau, “Comparative evaluation of the AccuProbe group B streptococcus culture test, the BD GeneOhm Strep B assay, and culture for detection of group B streptococci in pregnant women,” Journal of Clinical Microbiology, vol. 47, no. 9, pp. 3021–3023, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  36. J. R. Verani, L. McGee, and S. J. Schrag, “Prevention of perinatal group B streptococcal disease revised guidelines from CDC, 2010,” Morbidity and Mortality Weekly Report, vol. 59, no. 10, pp. 1–36, 2010. View at Scopus
  37. J. Thinkhamrop, S. Limpongsanurak, M. R. Festin et al., “Infections in international pregnancy study: performance of the optical immunoassay test for detection of group B streptococcus,” Journal of Clinical Microbiology, vol. 41, no. 11, pp. 5288–5290, 2003. View at Publisher · View at Google Scholar · View at Scopus
  38. H. Honest, S. Sharma, and K. S. Khan, “Rapid tests for group B streptococcus colonization in laboring women: a systematic review,” Pediatrics, vol. 117, no. 4, pp. 1055–1066, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  39. J. Daniels, J. Gray, H. Pattison et al., “Rapid testing for group B streptococcus during labour: a test accuracy study with evaluation of acceptability and cost-effectiveness.,” Health Technology Assessment, vol. 13, no. 42, pp. 1–154, 2009. View at Scopus
  40. D. J. Isaacman, R. B. Karasic, E. A. Reynolds, and S. I. Kost, “Effect of number of blood cultures and volume of blood on detection of bacteremia in children,” Journal of Pediatrics, vol. 128, no. 2, pp. 190–195, 1996. View at Publisher · View at Google Scholar · View at Scopus
  41. A. G. Kaditis, A. S. O'Marcaigh, K. H. Rhodes, A. L. Weaver, and N. K. Henry, “Yield of positive blood cultures in pediatric oncology patients by a new method of blood culture collection,” Pediatric Infectious Disease Journal, vol. 15, no. 7, pp. 615–620, 1996. View at Publisher · View at Google Scholar · View at Scopus
  42. T. G. Connell, M. Rele, D. Cowley, J. P. Buttery, and N. Curtis, “How reliable is a negative blood culture result? Volume of blood submitted for culture in routine practice in a children's hospital,” Pediatrics, vol. 119, no. 5, pp. 891–896, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  43. R. L. Schelonka, M. K. Chai, B. A. Yoder, D. Hensley, R. M. Brockett, and D. P. Ascher, “Volume of blood required to detect common neonatal pathogens,” Journal of Pediatrics, vol. 129, no. 2, pp. 275–278, 1996. View at Publisher · View at Google Scholar · View at Scopus
  44. D. N. Greenberg, D. P. Ascher, B. A. Yoder, D. M. Hensley, H. S. Heiman, and J. F. Keith III, “Sensitivity and specificity of rapid diagnostic tests for detection of group B streptococcal antigen in bacteremic neonates,” Journal of Clinical Microbiology, vol. 33, no. 1, pp. 193–198, 1995. View at Scopus
  45. M. Williamson, S. H. Fraser, and M. Tilse, “Failure of the urinary group B streptococcal antigen test as a screen for neonatal sepsis,” Archives of Disease in Childhood, vol. 73, no. 2, pp. F109–F111, 1995. View at Scopus
  46. J. A. Becker, D. P. Ascher, J. Mendiola et al., “False-negative urine latex particle agglutination testing in neonates with group B streptococcal bacteremia: a function of improper test implementation?” Clinical Pediatrics, vol. 32, no. 8, pp. 467–471, 1993. View at Scopus
  47. E. D. G. McIntosh and H. E. Jeffery, “Clinical application of urine antigen detection in early onset group B streptococcal disease,” Archives of Disease in Childhood, vol. 67, no. 10, pp. 1198–1200, 1992. View at Scopus
  48. W. E. Hachey and T. E. Wiswell, “Limitations in the usefulness of urine latex particle agglutination tests and hematologic measurements in diagnosing neonatal sepsis during the first week of life,” Journal of Perinatology, vol. 12, no. 3, pp. 240–245, 1992. View at Scopus
  49. S. M. Golden, D. M. Stamilio, B. M. Faux et al., “Evaluation of a real-time fluorescent PCR assay for rapid detection of group B Streptococci in neonatal blood,” Diagnostic Microbiology and Infectious Disease, vol. 50, no. 1, pp. 7–13, 2004. View at Publisher · View at Google Scholar · View at PubMed
  50. C. Y. Lin, C. H. Hsu, F. Y. Huang et al., “The changing face of early-onset neonatal sepsis after the implementation of a maternal group B streptococcus screening and intrapartum prophylaxis policy-a study in one medical center,” Pediatrics and Neonatology, vol. 52, no. 2, pp. 78–84, 2011. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  51. B. J. Stoll, N. I. Hansen, P. J. Sánchez et al., “Early onset neonatal sepsis: the burden of group B streptococcal and E. coli disease continues,” Pediatrics, vol. 127, no. 5, pp. 817–826, 2011. View at Publisher · View at Google Scholar · View at PubMed
  52. B. J. Stoll, N. Hansen, A. A. Fanaroff et al., “Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants,” The New England Journal of Medicine, vol. 347, no. 4, pp. 240–247, 2002. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  53. C. V. Towers, M. H. Cart, G. Padilla, and T. Asrat, “Potential consequences of widespread antepartal use of ampicillin,” American Journal of Obstetrics and Gynecology, vol. 179, no. 4, pp. 879–883, 1998. View at Publisher · View at Google Scholar · View at Scopus
  54. K. Mayor-Lynn, V. H. González-Quintero, M. J. O'Sullivan, A. I. Hartstein, S. Roger, and M. Tamayo, “Comparison of early-onset neonatal sepsis caused by Escherichia coli and group B streptococcus,” American Journal of Obstetrics and Gynecology, vol. 192, no. 5, pp. 1437–1439, 2005.
  55. J. I. Alos, T. Lambert, and P. Courvalin, “Comparison of two molecular methods for tracing nosocomial transmission of Escherichia coli K1 in a neonatal unit,” Journal of Clinical Microbiology, vol. 31, no. 7, pp. 1704–1709, 1993. View at Scopus
  56. D. Senerwa, O. Olsvik, L. N. Mutanda et al., “Enteropathogenic Escherichia coli serotype O111: HNT isolated from preterm neonates in Nairobi, Kenya,” Journal of Clinical Microbiology, vol. 27, no. 6, pp. 1307–1311, 1989. View at Scopus
  57. M. E. Speer, L. H. Taber, M. D. Yow, A. J. Rudolph, J. Urteaga, and S. Waller, “Fulminant neonatal sepsis and necrotizing enterocolitis associated with a “nonenteropathogenic” strain of Escherichia coli,” Journal of Pediatrics, vol. 89, no. 1, pp. 91–95, 1976.
  58. C. A. Friesen and C. T. Cho, “Characteristic features of neonatal sepsis due to Haemophilus influenzae,” Reviews of Infectious Diseases, vol. 8, no. 5, pp. 777–780, 1986. View at Scopus
  59. A. Schuchat, S. S. Zywicki, M. J. Dinsmoor et al., “Risk factors and opportunities for prevention of early-onset neonatal sepsis: a multicenter case-control study,” Pediatrics, vol. 105, no. 1, pp. 21–26, 2000. View at Scopus
  60. B. G. Gellin, C. V. Broome, W. F. Bibb, R. E. Weaver, S. Gaventa, and L. Mascola, “The epidemiology of listeriosis in the United States–1986,” American Journal of Epidemiology, vol. 133, no. 4, pp. 392–401, 1991.
  61. H. Hof, R. Lampidis, and J. Bensch, “Nosocomial listeria gastroenteritis in a newborn, confirmed by random amplification of polymorphic DNA,” Clinical Microbiology and Infection, vol. 6, no. 12, pp. 683–686, 2000. View at Publisher · View at Google Scholar · View at Scopus
  62. A. Schuchat, C. Lizano, C. V. Broome, B. Swaminathan, C. Kim, and K. Winn, “Outbreak of neonatal listeriosis associated with mineral oil,” Pediatric Infectious Disease Journal, vol. 10, no. 3, pp. 183–189, 1991. View at Scopus
  63. B. Muller-Pebody, A. P. Johnson, P. T. Heath, R. E. Gilbert, K. L. Henderson, and M. Sharland, “Empirical treatment of neonatal sepsis: are the current guidelines adequate?” Archives of Disease in Childhood, vol. 96, no. 1, pp. F4–F8, 2011. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  64. S. Vergnano, E. Menson, N. Kennea et al., “Neonatal infections in England: the neonIN surveillance network,” Archives of Disease in Childhood, vol. 96, no. 1, pp. F9–F14, 2011. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  65. M. Cohen-Wolkowiez, C. Moran, D. K. Benjamin et al., “Early and late onset sepsis in late preterm infants,” Pediatric Infectious Disease Journal, vol. 28, no. 12, pp. 1052–1056, 2009. View at Publisher · View at Google Scholar · View at Scopus
  66. P. N. le Souef and B. N. J. Walters, “Neonatal listeriosis. A summer outbreak,” Medical Journal of Australia, vol. 2, no. 4, pp. 188–191, 1981. View at Scopus
  67. R. Romero, H. N. Winn, M. Wan, and J. C. Hobbins, “Listeria monocytogenes chorioamnionitis and preterm labor,” American Journal of Perinatology, vol. 5, no. 3, pp. 286–288, 1988. View at Scopus
  68. C. B. Wilson and D. B. Lewis, “Basis and implications of selectively diminished cytokine production in neonatal susceptibility to infection,” Reviews of Infectious Diseases, vol. 12, supplement 4, pp. S410–S420, 1990. View at Scopus
  69. R. Mitchell, “Listeria and Erysipelothrix,” in Mackie and McCartney Practical Medical Microbiology, pp. 309–312, 14th edition.
  70. A. Schuchat, B. Swaminathan, and C. V. Broome, “Epidemiology of human listeriosis,” Clinical Microbiology Reviews, vol. 4, no. 2, pp. 169–183, 1991. View at Scopus
  71. S. Samanta, K. Farrer, A. Breathnach, and P. T. Heath, “Risk factors for late onset gram-negative infections: a case-control study,” Archives of Disease in Childhood, vol. 96, no. 1, pp. F15–F18, 2011. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  72. L. C. Downey, P. B. Smith, and D. K. Benjamin Jr., “Risk factors and prevention of late-onset sepsis in premature infants,” Early Human Development, vol. 86, supplement 1, pp. 7–12, 2010. View at Scopus
  73. B. J. Stoll, N. Hansen, A. A. Fanaroff et al., “Late-onset sepsis in very low birth weight neonates: the experience of the NICHD neonatal research network,” Pediatrics, vol. 110, no. 2, pp. 285–291, 2002. View at Publisher · View at Google Scholar · View at Scopus
  74. J. H. Jiang, N. C. Chiu, F. Y. Huang et al., “Neonatal sepsis in the neonatal intensive care unit: characteristics of early versus late onset,” Journal of Microbiology, Immunology and Infection, vol. 37, no. 5, pp. 301–306, 2004. View at Scopus
  75. M. Tojo, N. Yamashita, D. A. Goldmann, and G. B. Pier, “Isolation and characterization of a capsular polysaccharide adhesin from Staphylococcus epidermidis,” Journal of Infectious Diseases, vol. 157, no. 4, pp. 713–722, 1988. View at Scopus
  76. H. Shiro, G. Meluleni, A. Groll et al., “The pathogenic role of Staphylococcus epidermidis capsular polysaccharide/adhesin in a low-inoculum rabbit model of prosthetic valve endocarditis,” Circulation, vol. 92, no. 9, pp. 2715–2722, 1995. View at Scopus
  77. C. T. D'Angio, K. L. McGowan, S. Baumgart, S. J. Geme, and M. C. Harris, “Surface colonization with coagulase-negative staphylococci in premature neonates,” Journal of Pediatrics, vol. 114, no. 6, pp. 1029–1034, 1989. View at Scopus
  78. B. Adam, G. S. Baillie, and L. J. Douglas, “Mixed species biofilms of Candida albicans and Staphylococcus epidermidis,” Journal of Medical Microbiology, vol. 51, no. 4, pp. 344–349, 2002. View at Scopus
  79. M. A. C. Hemels, A. van den Hoogen, M. A. Verboon-Maciolek, A. Fleer, and T. G. Krediet, “Prevention of neonatal late-onset sepsis associated with the removal of percutaneously inserted central venous catheters in preterm infants,” Pediatric Critical Care Medicine, vol. 12, no. 4, pp. 445–448, 2011. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  80. W. Freeman, D. C. Weir, J. E. Whitehead et al., “Association between risk factors for coronary heart disease in schoolboys and adult mortality rates in the same localities,” Archives of Disease in Childhood, vol. 65, no. 1, pp. 78–83, 1990. View at Scopus
  81. C. Avila-Figueroa, D. A. Goldmann, D. K. Richardson, J. E. Gray, A. Ferrari, and J. Freeman, “Intravenous lipid emulsions are the major determinant of coagulase-negative staphylococcal bacteremia in very low birth weight newborns,” Pediatric Infectious Disease Journal, vol. 17, no. 1, pp. 10–17, 1998. View at Publisher · View at Google Scholar · View at Scopus
  82. M. G. Karlowicz, E. S. Buescher, and A. E. Surka, “Fulminant late-onset sepsis in a neonatal intensive care unit, 1988–1997, and the impact of avoiding empiric vancomycin therapy,” Pediatrics, vol. 106, no. 6, pp. 1387–1390, 2000. View at Scopus
  83. H. A. Lassiter, S. W. Watson, M. L. Seifring, and J. E. Tanner, “Complement factor 9 deficiency in serum of human neonates,” Journal of Infectious Diseases, vol. 166, no. 1, pp. 53–57, 1992. View at Scopus
  84. N. Y. Boo, A. J. Nordiah, H. Alfizah, A. H. Nor-Rohaini, and V. K. Lim, “Contamination of breast milk obtained by manual expression and breast pumps in mothers of very low birthweight infants,” Journal of Hospital Infection, vol. 49, no. 4, pp. 274–281, 2001. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  85. L. G. Donowitz, F. J. Marsik, K. A. Fisher, and R. P. Wenzel, “Contaminated breast milk: a source of Klebsiella bacteremia in a newborn intensive care unit,” Reviews of Infectious Diseases, vol. 3, no. 4, pp. 716–720, 1981. View at Scopus
  86. Centers for Disease Control and Prevention, “Enterobacter sakazakii infections associated with the use of powdered infant formula—Tennessee, 2001,” Morbidity and Mortality Weekly Report, vol. 51, no. 14, pp. 297–300, 2002.
  87. Ü. Parm, T. Metsvaht, E. Sepp et al., “Mucosal surveillance cultures in predicting Gram-negative late-onset sepsis in neonatal intensive care units,” Journal of Hospital Infection, vol. 78, no. 4, pp. 327–332, 2011. View at Publisher · View at Google Scholar · View at PubMed
  88. U. Arora and J. Jaitwani, “Acinetobacter spp.–an emerging pathogen in neonatal septicemia in Amritsar,” Indian Journal of Medical Microbiology, vol. 24, no. 1, p. 81, 2006. View at Scopus
  89. X. Corbella, A. Montero, M. Pujol et al., “Emergence and rapid spread of carbapenem resistance during a large and sustained hospital outbreak of multiresistant Acinetobacter baumannii,” Journal of Clinical Microbiology, vol. 38, no. 11, pp. 4086–4095, 2000. View at Scopus
  90. S. Roy, S. Basu, S. Dasgupta, A. K. Singh, and R. Viswanathan, “Carbapenem resistance in Acinetobacter baumannii isolated from blood of neonates with sepsis,” Indian Journal of Medical Microbiology, vol. 28, no. 4, pp. 416–417, 2010. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  91. Y. C. Huang, Y. H. Chou, L. H. Su, R. I. Lien, and T. Y. Lin, “Methicillin-resistant Staphylococcus aureus colonization and its association with infection among infants hospitalized in neonatal intensive care units,” Pediatrics, vol. 118, no. 2, pp. 469–474, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  92. S. I. Gerber, R. C. Jones, M. V. Scott et al., “Management of outbreaks of methicillin-resistant Staphylococcus aureus infection in the neonatal intensive care unit: a consensus statement,” Infection Control and Hospital Epidemiology, vol. 27, no. 2, pp. 139–145, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  93. K. S. Ko, S. Park, K. R. Peck et al., “Molecular characterization of methicillin-resistant Staphylococcus aureus spread by neonates transferred from primary obstetrics clinics to a tertiary care hospital in Korea,” Infection Control and Hospital Epidemiology, vol. 27, no. 6, pp. 593–597, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  94. H. Sax, K. Posfay-Barbe, S. Harbarth et al., “Control of a cluster of community-associated, methicillin-resistant Staphylococcus aureus in neonatology,” Journal of Hospital Infection, vol. 63, no. 1, pp. 93–100, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  95. P. Behari, J. Englund, G. Alcasid, S. Garcia-Houchins, and S. G. Weber, “Transmission of methicillin-resistant Staphylococcus aureus to preterm infants through breast milk,” Infection Control and Hospital Epidemiology, vol. 25, no. 9, pp. 778–780, 2004. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  96. S. Denniston and F. A. I. Riordan, “Staphylococcus aureus bacteraemia in children and neonates: a 10 year retrospective review,” Journal of Infection, vol. 53, no. 6, pp. 387–393, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  97. R. M. Fortunov, K. G. Hulten, W. A. Hammerman, E. O. Mason Jr., and S. L. Kaplan, “Evaluation and treatment of community-acquired Staphylococcus aureus infections in term and late-preterm previously healthy neonates,” Pediatrics, vol. 120, no. 5, pp. 937–945, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  98. J. Watson, R. C. Jones, C. Cortes et al., “Community-associated methicillin-resistant Staphylococcus aureus infection among healthy newborns–Chicago and Los Angeles County, 2004,” Morbidity and Mortality Weekly Report, vol. 55, no. 12, pp. 329–332, 2006. View at Scopus
  99. S. M. H. Aletayeb, A. D. Khosravi, M. Dehdashtian, F. Kompani, S. M. Mortazavi, and M. R. Aramesh, “Identification of bacterial agents and antimicrobial susceptibility of neonatal sepsis: a 54-month study in a tertiary hospital,” African Journal of Microbiology Research, vol. 5, no. 5, pp. 528–531, 2011.
  100. A. Jain and R. Mondal, “Prevalence & antimicrobial resistance pattern of extended spectrum β-lactamase producing Klebsiella spp isolated from cases of neonatal septicaemia,” Indian Journal of Medical Research, vol. 125, no. 1, pp. 89–94, 2007. View at Scopus
  101. C. Mammina, P. di Carlo, D. Cipolla et al., “Surveillance of multidrug-resistant gram-negative bacilli in a neonatal intensive care unit: prominent role of cross transmission,” American Journal of Infection Control, vol. 35, no. 4, pp. 222–230, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  102. V. Crivaro, M. Bagattini, M. F. Salza et al., “Risk factors for extended-spectrum β-lactamase-producing Serratia marcescens and Klebsiella pneumoniae acquisition in a neonatal intensive care unit,” Journal of Hospital Infection, vol. 67, no. 2, pp. 135–141, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  103. D. R. Linkin, N. O. Fishman, J. B. Patel, J. D. Merrill, and E. Lautenbach, “Risk factors for extended-spectrum beta-lactamase-producing enterobacteriaceae in a neonatal intensive care unit,” Infection Control and Hospital Epidemiology, vol. 25, no. 9, pp. 781–783, 2004. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  104. C. L. Pessoa-Silva, B. M. Moreira, V. C. Almeida, et al., “Extended-spectrum β-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit: risk factors for infection and colonization,” Journal of Hospital Infection, vol. 53, no. 3, pp. 198–206, 2003. View at Publisher · View at Google Scholar
  105. K. Kristóf, D. Szabó, J. W. Marsh et al., “Extended-spectrum beta-lactamase-producing Klebsiella spp. in a neonatal intensive care unit: risk factors for the infection and the dynamics of the molecular epidemiology,” European Journal of Clinical Microbiology and Infectious Diseases, vol. 26, no. 8, pp. 563–570, 2007. View at Publisher · View at Google Scholar · View at PubMed
  106. J. Klein and S. Marcy, “Bacterial sepsis and meningitidis,” in Infectious Diseases of the Fetus and Newborn Infant, J. S. Remington and J. O. Klein, Eds., pp. 601–656, WB Saunders, Philadelphia, Pa, USA, 3rd edition, 1990.
  107. B. Stenson, “Blood cultures volume from neonates,” 1999.
  108. Becton Dickinson Microbiological Systems, BECTEC PEDS PLUS/F Culture Vials: Instruction Leaflet, Becton Dickinson and Company, Sparks, Md, USA, 2000.
  109. J. Buttery, M. Herbert, I. Tallach, et al., Neonatal Blood Cultures: How Much Blood Do We Take?European Society of Pediatric Infectious Diseases, Istanbul, Turkey.
  110. D. E. Dietzman, G. W. Fischer, and F. D. Schoenknecht, “Neonatal Escherichia coli septicemia–bacterial counts in blood,” Journal of Pediatrics, vol. 85, no. 1, pp. 128–130, 1974. View at Scopus
  111. J. A. Washington II and D. M. Ilstrup, “Blood cultures: issues and controversies,” Reviews of Infectious Diseases, vol. 8, no. 5, pp. 792–802, 1986. View at Scopus
  112. J. A. Kellogg, F. L. Ferrentino, M. H. Goodstein, J. Liss, S. L. Shapiro, and D. A. Bankert, “Frequency of low level bacteremia in infants from birth to two months of age,” Pediatric Infectious Disease Journal, vol. 16, no. 4, pp. 381–385, 1997. View at Publisher · View at Google Scholar · View at Scopus
  113. J. A. Kellogg, J. P. Manzella, and D. A. Bankert, “Frequency of low-level bacteremia in children from birth to fifteen years of age,” Journal of Clinical Microbiology, vol. 38, no. 6, pp. 2181–2185, 2000. View at Scopus
  114. S. E. Phillips and J. S. Bradley, “Bacteremia detected by lysis direct plating in a neonatal intensive care unit,” Journal of Clinical Microbiology, vol. 28, no. 1, pp. 1–4, 1990. View at Scopus
  115. P. Kite, V. Langdale, N. Todd, M. R. Millar, and P. MacKay, “Direct isolation of coagulase-negative staphylococci from neonatal blood samples,” Journal of Hospital Infection, vol. 14, no. 2, pp. 135–140, 1989. View at Scopus
  116. W. A. Durbin, E. G. Szymczak, and D. A. Goldmann, “Quantitative blood cultures in childhood bacteremia,” Journal of Pediatrics, vol. 92, no. 5, pp. 778–780, 1978. View at Scopus
  117. D. F. Welch, R. K. Scribner, and D. Hensel, “Evaluation of a lysis direct plating method for pediatric blood cultures,” Journal of Clinical Microbiology, vol. 21, no. 6, pp. 955–958, 1985. View at Scopus
  118. D. R. Brown, D. Kutler, B. Rai, T. Chan, and M. Cohen, “Bacterial concentration and blood volume required for a positive blood culture,” Journal of Perinatology, vol. 15, no. 2, pp. 157–159, 1995. View at Scopus
  119. F. Solorzano-Santos, M. G. Miranda-Novales, B. Leanos-Miranda, H. Diaz-Ponce, and G. Palacios-Saucedo, “A blood micro-culture system for the diagnosis of bacteremia in pediatric patients,” Scandinavian Journal of Infectious Diseases, vol. 30, no. 5, pp. 481–483, 1998. View at Publisher · View at Google Scholar
  120. M. D. Aronson and D. H. Bor, “Blood cultures,” Annals of Internal Medicine, vol. 106, no. 2, pp. 246–253, 1987. View at Scopus
  121. R. Auckenthaler, D. M. Ilstrup, and J. A. Washington II, “Comparison of recovery of organisms from blood cultures diluted 10% (volume/volume) and 20% (volume/volume),” Journal of Clinical Microbiology, vol. 15, no. 5, pp. 860–864, 1982. View at Scopus
  122. J. K. Kennaugh, W. W. Gregory, K. R. Powell, and J. O. Hendley, “The effect of dilution during culture on detection of low concentrations of bacteria in blood,” Pediatric Infectious Disease, vol. 3, no. 4, pp. 317–318, 1984. View at Scopus
  123. A. L. Kovatch and E. R. Wald, “Evaluation of the febrile neonate,” Seminars in Perinatology, vol. 9, no. 1, pp. 12–19, 1985.
  124. R. L. Wientzen Jr. and G. H. McCracken Jr., “Pathogenesis and management of neonatal sepsis and meningitis,” Current Problems in Pediatrics, vol. 8, no. 2, pp. 1–61, 1977. View at Scopus
  125. T. E. Wiswell and W. E. Hachey, “Multiple site blood cultures in the initial evaluation for neonatal sepsis during the first week of life,” Pediatric Infectious Disease Journal, vol. 10, no. 5, pp. 365–369, 1991. View at Scopus
  126. H. D. Wilson and H. F. Eichenwald, “Sepsis neonatorum,” Pediatric Clinics of North America, vol. 21, no. 3, pp. 571–582, 1974. View at Scopus
  127. S. P. Gotoff and R. E. Behrman, “Neonatal septicemia,” Journal of Pediatrics, vol. 76, no. 1, pp. 142–153, 1970. View at Scopus
  128. F. R. Cockerill III, J. G. Hughes, E. A. Vetter et al., “Analysis of 281,797 consecutive blood cultures performed over an eight-year period: trends in microorganisms isolated and the value of anaerobic culture of blood,” Clinical Infectious Diseases, vol. 24, no. 3, pp. 403–418, 1997. View at Scopus
  129. D. C. Shanson, “Blood culture technique: current controversies,” Journal of Antimicrobial Chemotherapy, vol. 25, supplement C, pp. 17–29, 1990.
  130. A. A. Fanaroff, S. B. Korones, L. L. Wright et al., “Incidence, presenting features, risk factors and significance of late onset septicemia in very low birth weight infants,” Pediatric Infectious Disease Journal, vol. 17, no. 7, pp. 593–598, 1998. View at Publisher · View at Google Scholar
  131. B. J. Stoll, T. Gordon, S. B. Korones et al., “Late-onset sepsis in very low birth weight neonates: a report from the national institute of child health and human development neonatal research network,” Journal of Pediatrics, vol. 129, no. 1, pp. 63–71, 1996. View at Scopus
  132. J. S. Abramson, K. D. Hampton, S. Babu, B. L. Wasilauskas, and M. J. Marcon, “The use of C-reactive protein from cerebrospinal fluid for differentiating meningitis from other central nervous system diseases,” Journal of Infectious Diseases, vol. 151, no. 5, pp. 854–858, 1985.
  133. M. E. Weisse, J. W. Bass, and L. M. Young, “Pediatric blood culture: comparison of yields using aerobic, anaerobic and hypertonic media,” Pediatric Infectious Disease Journal, vol. 11, no. 2, pp. 123–125, 1992. View at Scopus
  134. P. Yagupsky and F. S. Nolte, “Quantitative aspects of septicemia,” Clinical Microbiology Reviews, vol. 3, no. 3, pp. 269–279, 1990. View at Scopus
  135. S. Sarkar, I. Bhagat, J. D. DeCristofaro, T. E. Wiswell, and A. R. Spitzer, “A study of the role of multiple site blood cultures in the evaluation of neonatal sepsis,” Journal of Perinatology, vol. 26, no. 1, pp. 18–22, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  136. J. Li, J. J. Plorde, and L. G. Carlson, “Effects of volume and periodicity on blood cultures,” Journal of Clinical Microbiology, vol. 32, no. 11, pp. 2829–2831, 1994. View at Scopus
  137. K. Guerti, H. Devos, M. M. Ieven, and L. M. Mahieu, “Time to positivity of neonatal blood cultures: fast and furious?” Journal of Medical Microbiology, vol. 60, no. 4, pp. 446–453, 2011. View at Publisher · View at Google Scholar · View at PubMed
  138. J. P. Buttery, “Blood cultures in newborns and children: optimising an everyday test,” Archives of Disease in Childhood, vol. 87, no. 1, pp. F25–F28, 2002. View at Scopus
  139. J. D. Thylefors, S. Harbarth, and D. Pittet, “Increasing bacteremia due to coagulase-negative staphylococci: fiction or reality?” Infection Control and Hospital Epidemiology, vol. 19, no. 8, pp. 581–589, 1998. View at Scopus
  140. M. P. Weinstein, “Current blood culture methods and systems: clinical concepts, technology, and interpretation of results,” Clinical Infectious Diseases, vol. 23, no. 1, pp. 40–46, 1996. View at Scopus
  141. M. K. Hurst and B. A. Yoder, “Detection of bacteremia in young infants: is 48 hours adequate?” Pediatric Infectious Disease Journal, vol. 14, no. 8, pp. 711–713, 1995. View at Scopus
  142. K. L. McGowan, J. A. Foster, and S. E. Coffin, “Outpatient pediatric blood cultures: time to positivity,” Pediatrics, vol. 106, no. 2, pp. 251–255, 2000. View at Scopus
  143. M. Fujimori, K. Hisata, S. Nagata et al., “Efficacy of bacterial ribosomal RNA-targeted reverse transcription-quantitative PCR for detecting neonatal sepsis: a case control study,” BMC Pediatrics, vol. 10, p. 53, 2010. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  144. A. del Vecchio, N. Laforgia, M. Capasso, A. Iolascon, and G. Latini, “The role of molecular genetics in the pathogenesis and diagnosis of neonatal sepsis,” Clinics in Perinatology, vol. 31, no. 1, pp. 53–67, 2004. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  145. J. A. Jordan and M. B. Durso, “Real-time polymerase chain reaction for detecting bacterial DNA directly from blood of neonates being evaluated for sepsis,” Journal of Molecular Diagnostics, vol. 7, no. 5, pp. 575–581, 2005. View at Scopus
  146. C. M. Cotten, S. Taylor, B. Stoll et al., “Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants,” Pediatrics, vol. 123, no. 1, pp. 58–66, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  147. M. Paolucci, M. P. Landini, and V. Sambri, “Conventional and molecular techniques for the early diagnosis of bacteraemia,” International Journal of Antimicrobial Agents, vol. 36, supplement 2, pp. S6–S16, 2010. View at Publisher · View at Google Scholar · View at PubMed
  148. M. Venkatesh, A. Flores, R. A. Luna, and J. Versalovic, “Molecular microbiological methods in the diagnosis of neonatal sepsis,” Expert Review of Anti-Infective Therapy, vol. 8, no. 9, pp. 1037–1048, 2010. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  149. C. R. Woese, “Bacterial evolution,” Microbiological Reviews, vol. 51, no. 2, pp. 221–271, 1987. View at Scopus
  150. D. A. Relman, “The search for unrecognized pathogens,” Science, vol. 284, no. 5418, pp. 1308–1310, 1999. View at Publisher · View at Google Scholar · View at Scopus
  151. U. Evertsson, H. J. Monstein, and A. G. Johansson, “Detection and identification of fungi in blood using broad-range 28S rDNA PCR amplification and species-specific hybridisation,” APMIS, vol. 108, no. 5, pp. 385–392, 2000. View at Scopus
  152. C. Schabereiter-Gurtner, M. Nehr, P. Apfalter, A. Makristathis, M. L. Rotter, and A. M. Hirschl, “Evaluation of a protocol for molecular broad-range diagnosis of culture-negative bacterial infections in clinical routine diagnosis,” Journal of Applied Microbiology, vol. 104, no. 4, pp. 1228–1237, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  153. T. Reier-Nilsen, T. Farstad, B. Nakstad, V. Lauvrak, and M. Steinbakk, “Comparison of broad range 16S rDNA PCR and conventional blood culture for diagnosis of sepsis in the newborn: a case control study,” BMC Pediatrics, vol. 9, p. 5, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  154. N. Laforgia, B. Coppola, R. Carbone, A. Grassi, A. Mautone, and A. Iolascon, “Rapid detection of neonatal sepsis using polymerase chain reaction,” Acta Paediatrica, vol. 86, no. 10, pp. 1097–1099, 1997. View at Scopus
  155. J. A. Jordan, M. B. Durso, A. R. Butchko, J. G. Jones, and B. S. Brozanski, “Evaluating the near-term infant for early early onset sepsis: progress and challenges to consider 16S rDNA polymerase chain reaction testing,” Journal of Molecular Diagnostics, vol. 8, no. 3, pp. 357–363, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  156. O. Esparcia, M. Montemayor, G. Ginovart et al., “Diagnostic accuracy of a 16S ribosomal DNA gene-based molecular technique (RT-PCR, microarray, and sequencing) for bacterial meningitis, early-onset neonatal sepsis, and spontaneous bacterial peritonitis,” Diagnostic Microbiology and Infectious Disease, vol. 69, no. 2, pp. 153–160, 2011. View at Publisher · View at Google Scholar · View at PubMed
  157. A. K. Yadav, C. G. Wilson, P. L. Prasad, and P. K. Menon, “Polymerase chain reaction in rapid diagnosis of neonatal sepsis,” Indian Pediatrics, vol. 42, no. 7, pp. 681–685, 2005. View at Scopus
  158. Y. D. Wu, L. H. Chen, X. J. Wu et al., “Gram stain-specific-probe-based real-time PCR for diagnosis and discrimination of bacterial neonatal sepsis,” Journal of Clinical Microbiology, vol. 46, no. 8, pp. 2613–2619, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  159. K. Y. Y. Chan, H. S. Lam, H. M. Cheung et al., “Rapid identification and differentiation of Gram-negative and Gram-positive bacterial bloodstream infections by quantitative polymerase chain reaction in preterm infants,” Critical Care Medicine, vol. 37, no. 8, pp. 2441–2447, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  160. M. Enomoto, I. Morioka, T. Morisawa, N. Yokoyama, and M. Matsuo, “A novel diagnostic tool for detecting neonatal infections using multiplex polymerase chain reaction,” Neonatology, vol. 96, no. 2, pp. 102–108, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  161. S. Dutta, A. Narang, A. Chakraborty, and P. Ray, “Diagnosis of neonatal sepsis using universal primer polymerase chain reaction before and after starting antibiotic drug therapy,” Archives of Pediatrics and Adolescent Medicine, vol. 163, no. 1, pp. 6–11, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  162. M. Paolucci, M. G. Capretti, P. dal Monte et al., “Laboratory diagnosis of late-onset sepsis in newborns by multiplex real-time PCR,” Journal of Medical Microbiology, vol. 58, no. 4, pp. 533–534, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  163. B. Lucignano, S. Ranno, O. Liesenfeld et al., “Multiplex PCR allows rapid and accurate diagnosis of bloodstream infections in newborns and children with suspected sepsis,” Journal of Clinical Microbiology, vol. 49, no. 6, pp. 2252–2258, 2011. View at Publisher · View at Google Scholar · View at PubMed