title: Routine skin cultures in predicting sepsis pathogens among hospitalized preterm neonates in Bangladesh.
abstract: BACKGROUND
  Few studies from developing countries have examined sensitivity, specificity, positive and negative predictive values of routine surface cultures.
  
  
  OBJECTIVE
  The purpose of the study was to determine sensitivity, specificity, and positive predictive value (PPV) of skin cultures among preterm neonates admitted to Dhaka Shishu Hospital, Bangladesh.
  
  
  METHODS
  The study was nested within a prospective, randomized, controlled trial of emollient treatment in Dhaka Shishu Hospital, Bangladesh. A total of 497 preterm infants <33 weeks gestational age and <72 h of chronological age were enrolled, and the sensitivity, specificity, and PPV of skin cultures were analyzed among 3,765 blood-skin culture pairs, wherein the skin culture was obtained within 13 days before the blood culture.
  
  
  RESULTS
  Overall sensitivity, specificity, and PPV were 16, 38, and 5%, respectively. PPV during Klebsiella pneumoniae outbreaks was about 9%, and the inguinal site had the highest PPV (6%) among the three skin sites. Acinetobacter spp.- and K. pneumoniae-specific PPVs were 28 and 23%, respectively. PPV was <2% for Candida spp., Enterobacter spp., and Salmonella spp.
  
  
  CONCLUSIONS
  Routine skin culture is inefficient in predicting the pathogen responsible for sepsis among premature neonates, even in a developing country setting, where the burden of bacterial infection is relatively high. Skin cultures are also of limited utility during K. pneumoniae outbreaks, and are not recommended.
authors.affiliation: Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md. 21205, USA.
authors.forename: Yoonjoung
authors.initials: Y
authors.lastname: Choi
authors.forename: Samir K
authors.initials: SK
authors.lastname: Saha
authors.forename: A S M Nawshad Uddin
authors.initials: AS
authors.lastname: Ahmed
authors.forename: Paul A
authors.initials: PA
authors.lastname: Law
authors.forename: M A K Azad
authors.initials: MA
authors.lastname: Chowdhury
authors.forename: Maksuda
authors.initials: M
authors.lastname: Islam
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
mesh_terms: D000465:Algorithms; D001419:Bacteria / Q000302:isolation & purification*; D001459:Bangladesh; D003428:Cross Infection / Q000175:diagnosis / Q000382:microbiology*; D006760:Hospitalization; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood; D007363:Intensive Care Units, Neonatal; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000382:microbiology*; D012867:Skin / Q000382:microbiology*