The prevalence of blood culture proven sepsis in the present study was 43.1%. This is similar to the 41.7% reported by Chako and Sohi [17
], 42% by Mustafa et al. [15
] and 47.5% by Roy et al. [18
]. It is however higher than the 36.4% reported by Antia-Obong and Utsalo [19
], 28% by Zeeshan et al. [20
], 14% by Manucha et al. [21
] and 10.7% by Ugochukwu [22
The commonest organism isolated was klebsiella pneumonia followed by staphylococcus areus. From 1974 to 1978, Omene [3
] in Benin city found Escherichia coli to be the predominant bacterial isolate in neonatal sepsis. Antia Obong and Utsalo [19
] in Calabar reported Staphylococcus aureus as the predominant bacterial isolate from 1985 to 1987. Ugochukwu [23
] also found Staphylococcus aureus as the predominant bacterial isolate in neonatal sepsis in Nnewi Nigeria, from 1998 to 2001. This shows a changing pattern of bacterial isolates over the years in the Southern region of Nigeria. Similar to the finding in the present study, Roy et al. [18
] in India reported Klebsiella spp as the predominant bacterial isolate in neonatal sepsis.
Among the clinical features of neonatal sepsis in the present study, CRP performance was highest in neonates with apnoea, vomiting and lethargy and lowest in those with hypothermia and convulsion. The lower levels in neonates with hypothermia and convulsion may be due to the fact that there are other commoner causes of neonatal hypothermia and convulsions other than sepsis.
Among the risk factors for neonatal sepsis, CRP performance was highest in neonates born to mothers with foul smelling amniotic fluid, followed by peri-partum pyrexia. This is similar to findings by Mathai et al. [23
] in Tamil, Nadu who reported a significant association between maternal peri-partum pyrexia and neonatal positive CRP levels. Unlike the present study however, they found no significant association between foul smelling amniotic fluid and positive CRP levels.
In the present study, CRP identified 134 out of 181 neonates who had culture-proven sepsis, with sensitivity of 74.0% and a negative predictive value of 79.0%, implying that close to three quarters of neonates with suspected sepsis will be correctly diagnosed using CRP. This means that one out of every four neonates with sepsis will be missed. This is much too high to base the decision not to start empirical antibiotics for a neonate with suspected sepsis. Particularly as CRP was only tested to predict positive blood culture which may represent only a proportion of neonates with sepsis [24
], especially if the patient had been on antibiotic therapy before presentation as is common in Sub-Saharan Africa. A negative CRP, however can be useful in aiding the decision to discontinue antibiotics especially if the neonate has no clinical feature of sepsis. Kashabi et al. [13
] demonstrated that CRP can be a useful guide in making a decision to discontinue antibiotic therapy, thus facilitating early discharge with significantly reduced cost, complications of treatment and family anxiety.
Several authors in different settings have reported different performances for usefulness of CRP in the diagnosis and management of neonatal sepsis. The main differences and the CRP performances are as outlined in Table . Nuntnarumit et al. [25
] in Bangkok Thailand, reported the highest sensitivity, specificity, positive predictive values and negative predictive value. This is probably due to the quantitative sampling method which they used as compared to the qualitative method used in the present study. Also as shown in Table , authors who used the quantitative method for measurement of CRP reported higher performance values than those who used the qualitative method.
Performance of CRP in different settings