scholarly journals Evaluation of Early Onset Sepsis, Complete Blood Count, and Antibiotic Use in Gastroschisis

2017 ◽  
Vol 35 (04) ◽  
pp. 385-389
Author(s):  
Sadie Williams ◽  
Matthew Leonard ◽  
Eric Hall ◽  
Jose Perez ◽  
Jacqueline Wessel ◽  
...  
Keyword(s):  
Early Onset ◽  
Complete Blood Count ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Control Group ◽  
Typically Develop ◽  
Early Onset Sepsis ◽  
Mature Neutrophil ◽  
Reliable Marker ◽  
Culture Positive

Objective Gastroschisis is a congenital defect in which the abdominal viscera herniate through the abdominal wall. In this population, antibiotics are often initiated immediately following delivery; however, this may be unnecessary as infections typically develop as a consequence of chronic issues in gastroschisis. The objective of this study was to evaluate the incidence of culture positive early onset sepsis, the reliability of the immature to mature neutrophil count (I:T) ratio as an infectious biomarker, and antibiotic use in infants with gastroschisis. Study Design This retrospective chart review analyzed clinical data from 103 infants with gastroschisis and 103 weight-matched controls that were evaluated for early onset infection. Results Compared with the control group, there was a significantly increased percentage of infants with an I:T ratio > 0.2 in the gastroschisis group (43% vs. 12%, p < 0.001) and an increased percentage of infants exposed to greater than 5 days of antibiotics regardless of their I:T ratio (75% vs. 6%, p < 0.001). There were no episodes of culture positive early onset sepsis in either group. Conclusion Our results indicate that I:T ratio is not a reliable marker of infection in gastroschisis, and suggest that empiric septic evaluation and antibiotic use, immediately following delivery in gastroschisis infants, may be unnecessary.

scholarly journals Evaluation of compliance with the 2017 Canadian Paediatric Society Position Statement for the management of newborns at risk for early-onset sepsis: A retrospective cohort study

2020 ◽  
Author(s):  
Marina Simeonova ◽  
Jolanta Piszczek ◽  
Sannifer Hoi ◽  
Curtis Harder ◽  
Gustavo Pelligra
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Early Onset ◽  
Management Strategies ◽  
Retrospective Chart Review ◽  
Position Statement ◽  
Paediatric Society ◽  
Early Onset Sepsis ◽  
Inappropriate Antibiotics ◽  
Culture Positive

Abstract Introduction Due to the nonspecific clinical presentation, clinicians often empirically treat newborns at risk of early-onset sepsis (EOS). Recently, the Canadian Paediatric Society (CPS) published updated recommendations that promote a more judicious approach to EOS management. Objective To examine the compliance with the CPS statement at a tertiary perinatal site and characterize the types of deviations. Methods A retrospective chart review was conducted for all term and late pre-term newborns at risk for sepsis, between January 1 and June 30, 2018. The prevalence of newborns with EOS risk factors was measured during the first month. Management strategies for eligible newborns during the 6-month period were compared to the CPS recommendations to establish the rate of noncompliance. The type of noncompliance, readmission rate, and rate of culture-positive EOS were examined. Results In the first month, 29% (66 of 228) of newborns had EOS risk factors. Among the 100 newborns born in the 6-month period for whom the CPS recommendations apply, 47 (47%) received noncompliant management. Of those, 51% (N=24) had inappropriately initiated investigations, 17% (N=8) had inappropriate antibiotics, and 32% (N=15) had both. The rate of readmission for a septic workup was 1.6% (N= 2). None had culture-positive sepsis while admitted. Conclusion A large proportion of term and late preterm newborns (29%) had EOS risk factors, but none had culture-confirmed EOS. The rate of noncompliance with the CPS recommendations was high (47%), mainly due to overzealous management. Future initiatives should aim at increasing compliance, particularly in newborns at lower EOS risk.

Implementation and Evaluation of the Early-Onset Sepsis Risk Calculator in a High-Risk University Nursery

2017 ◽  
Vol 57 (9) ◽  
pp. 1080-1085 ◽  
Author(s):  
Jessica B. Beavers ◽  
Shasha Bai ◽  
Jennifer Perry ◽  
Jordan Simpson ◽  
Sara Peeples
Keyword(s):  
Early Onset ◽  
Neonatal Intensive Care ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Risk Calculator ◽  
Admission Rates ◽  
Early Onset Sepsis ◽  
Sepsis Risk ◽  
Control And Prevention ◽  
Nicu Admission

There is growing interest in the Kaiser early-onset sepsis (EOS) risk calculator though institutions are hesitant to deviate from the Centers for Disease Control and Prevention guidelines and implement this in their hospitals. We describe the process of implementing routine use of the risk calculator in term and late preterm newborns delivered to mothers with chorioamnionitis in a level III neonatal intensive care unit (NICU). A retrospective chart review of infants delivered to mothers with chorioamnionitis from 2011 to 2014 was performed. Implementation of routine use of the calculator began in January 2015; preintervention and postintervention data were analyzed after a 9-month period of routine use. Following implementation, NICU admission rates, number of blood cultures drawn, and rates of antibiotic use dropped by 54%, 42%, and 59%, respectively ( P < .001). No negative outcomes were reported. In this article, we describe how the calculator was safely implemented in our NICU while decreasing the number of interventions.

scholarly journals Managing Infants Exposed to Maternal Chorioamnionitis by the Use of Early-Onset Sepsis Calculator

2019 ◽  
Vol 6 ◽  
pp. 2333794X1983371 ◽  
Author(s):  
Vinay Sharma ◽  
Constance Adkisson ◽  
Kunal Gupta
Keyword(s):  
Gestational Age ◽  
Early Onset ◽  
Neonatal Intensive Care ◽  
Complete Blood Count ◽  
Admission Rate ◽  
Antibiotic Use ◽  
Laboratory Evaluation ◽  
Utilization Rate ◽  
Early Onset Sepsis ◽  
Sepsis Calculator

Objective. To reduce neonatal intensive care unit admission rate (NAR) and antibiotic utilization rate (AUR) in ≥36 weeks gestational age infants exposed to maternal chorioamnionitis (MC) through the application of early-onset sepsis calculator (EOSCAL). Study Design. This is a single-center cohort study. All infants born ≥36 weeks gestational age and exposed to MC were compared for NAR, AUR, and laboratory evaluation rate (LER) 2 years after and 1 year before the implementation of EOSCAL. Results. There is a significant decrease in NAR ( P < .001), AUR ( P < .04), and LER for blood culture, complete blood count, and C-reactive protein ( P < .001) after implementation of EOSCAL. If infants received antibiotics, it was for significantly less number of doses ( P < .01). There was no increase in the readmission rate. Conclusion. Use of EOSCAL significantly decreases the rate of NAR, AUR, and LER in infants exposed to MC, without affecting readmission rates and late antibiotic use.

scholarly journals Vancomycin-Resistant Enterococci and Extended-Spectrum β-Lactamase-Producing Bacterial Colonization of the Cervix after Emergency Cerclage: Is It Safe?

Antibiotics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 933
Author(s):  
Won-Kyu Jang ◽  
Jin-Gon Bae
Keyword(s):  
Early Onset ◽  
Neonatal Death ◽  
Medical Center ◽  
Bacterial Colonization ◽  
Control Group ◽  
Vancomycin Resistant Enterococci ◽  
Extended Spectrum ◽  
Early Onset Sepsis ◽  
Cervical Surgery ◽  
Vancomycin Resistant

Antimicrobial resistance is currently becoming a global threat to human health. We performed a retrospective study on patients who underwent emergency cerclage between January 2016 and December 2018 at the Dongsan Medical Center. Cervical culture was first performed before surgery to confirm that there was no infection and was repeated on days 1, 4, and 7 after surgery. A total of 85 pregnant women underwent emergency cerclage. Among them, six patients had vancomycin-resistant enterococci (VRE) colonization in the cervix after cerclage, and 23 patients developed extended-spectrum β-lactamase (ESBL)-producing bacterial colonization in the cervix. The average gestational age at delivery was lower in the VRE group. Neonatal death was also significantly higher in the VRE group. The rate of occurrence of early-onset sepsis was also higher in the VRE group, and both VRE and ESBL-producing bacterial colonization cases in which early-onset sepsis occurred resulted in neonatal death. The prognosis of cervical VRE colonization after cervical surgery was poor, whereas the prognosis of ESBL-producing bacterial colonization in the cervix did not differ significantly from that of the control group. However, careful neonatal treatment is required considering that early-onset sepsis is fatal to the newborn.

scholarly journals Clinical profile and outcome of early onset sepsis in high risk very low birth weight neonates

2018 ◽  
Vol 5 (2) ◽  
pp. 389 ◽  
Author(s):  
Omprakash S. Shukla ◽  
Aditi Rawat
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Blood Culture ◽  
Low Birth Weight ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Very Low Birth Weight ◽  
Gram Negative ◽  
Early Onset Sepsis ◽  
Culture Positive

Background: Neonatal sepsis is one of the main causes of mortality and morbidity, especially in very low birth weight neonates (birth weight <1499 grams) despite the progress in hygiene, introduction of new and potent antimicrobial agents for treatment and advanced measures for diagnosis. The aim of the study was to find correlation of clinical features and risk factors of neonatal sepsis in culture positive cases.Methods: A cross- sectional study was carried out in one hundred neonates with risk factors of septicemia after obtaining informed consent. Blood culture was done using Bactec Peds Plus/F Culture as a gold standard to diagnose septicaemia. Correlation of  risk factors, clinical features with laboratory findings was obtained by using chi-square test. p-value of less than 0.05 was considered as significant.Results: Out of 100 neonates with suspected sepsis, BACTEC culture proven sepsis was seen in 40% cases. Gram negative sepsis was seen in 62.5% cases. The most common bacteria for early onset sepsis were Klebsiella, Pseudomonas and MRSA contributing 17% each to the bacteriological profile. The most common predisposing factor and clinical feature in culture positive cases were Premature rupture of membrane >24 hours (67%) and bleeding/petechia/pupura (72%) respectively. The major cause of mortality was pulmonary hemorrhage.Conclusions: Gram negative organism were more common and associated with higher mortality. Blood culture positivity increases with increase in number of risk factors in neonatal septicemia. A detailed history and thorough clinical examination is vital for early recognition of sepsis. 

Optimizing antibiotic use for early onset sepsis: A tertiary NICU experience

2019 ◽  
Vol 12 (3) ◽  
pp. 301-312 ◽  
Author(s):  
V. Arora ◽  
D. Strunk ◽  
S.H. Furqan ◽  
L. Schweig ◽  
C. Lefaiver ◽  
...  
Keyword(s):  
Early Onset ◽  
Antibiotic Use ◽  
Early Onset Sepsis

Implementation of the Early-Onset Sepsis Risk Calculator at a Community Level I Nursery

2021 ◽  
pp. 000992282110647
Author(s):  
Sharmila Oak ◽  
Melanie Stempowski ◽  
Erin Frank
Keyword(s):  
Early Onset ◽  
Antibiotic Use ◽  
Culture Collection ◽  
Risk Calculator ◽  
Community Based ◽  
Exact Test ◽  
Early Onset Sepsis ◽  
Sepsis Risk ◽  
Level 1 ◽  
Level I

The objective of this retrospective cohort study was to decrease the frequency of laboratory draws and the number of neonates receiving empiric antibiotics who are born to mothers with chorioamnionitis from 100% to 50% 6 months following implementation of the sepsis risk calculator (SRC) at a level 1 community nursery. Data were compared pre- and post-implementation of the SRC using the Fischer’s exact test. The rate of intravenous (IV) antibiotic use decreased from 93% to 7% ( P < .0001). The rate of blood culture collection decreased from 100% to 46% ( P < .0001). With implementation of the SRC, administration of IV antibiotics, laboratory draws, and IV placement significantly decreased without increasing rates of early-onset sepsis in our patient population. Our study demonstrated that the SRC can be effectively and safely implemented at a level 1 community–based newborn nursery, resulting in a decrease in unnecessary medical treatment without negative patient outcomes.

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