Dual-site blood culture yield and time to positivity in neonatal late-onset sepsis

2021 ◽  
pp. fetalneonatal-2021-322844
Author(s):  
Sarah A Coggins ◽  
Mary Catherine Harris ◽  
Lakshmi Srinivasan
Keyword(s):  
Neonatal Intensive Care ◽  
Late Onset ◽  
Time To Positivity ◽  
Late Onset Sepsis ◽  
Culture Growth ◽  
Peripheral Site ◽  
Dual Site ◽  
Culture Yield ◽  
Similar Yield ◽  
Culture Site

ObjectiveTo determine whether culture yield and time to positivity (TTP) differ between peripheral and central vascular catheter-derived blood cultures (BCx) in neonatal intensive care unit (NICU) patients evaluated for late-onset sepsis.DesignSingle-centre, retrospective, observational study.SettingLevel IV NICU.ParticipantsThe study included infants >72 hours old admitted to NICU in 2007–2019 with culture-confirmed bacteraemia. All episodes had simultaneous BCx drawn from a peripheral site and a vascular catheter (‘catheter culture’).Main outcome measuresDual-site culture yield and TTP.ResultsAmong 179 episodes of late-onset bacteraemia (among 167 infants) with concurrently drawn peripheral and catheter BCx, the majority (67%, 120 of 179) were positive from both sites, compared with 17% (30 of 179) with positive catheter cultures only and 16% (29 of 179) with positive peripheral cultures only. 66% (19 of 29) of episodes with only positive peripheral BCx grew coagulase-negative Staphylococcus, while 34% (10 of 29) were recognised bacterial pathogens. Among 120 episodes with both peripheral and catheter BCx growth, catheter cultures demonstrated bacterial growth prior to paired peripheral cultures in 78% of episodes (93 of 120, p<0.001). The median TTP was significantly shorter in catheter compared with peripheral cultures (15.0 hours vs 16.8 hours, p<0.001). The median elapsed time between paired catheter and peripheral culture growth was 1.3 hours.ConclusionConcurrently drawn peripheral and catheter BCx had similar yield. While a majority of episodes demonstrated dual-site BCx growth, a small but important minority of episodes grew virulent pathogens from either culture site alone. While dual-site culture practices may be useful, clinicians should balance the gain in sensitivity of bacteraemia detection against additive contamination risk.

Implementing Potentially Better Practices to Improve Neonatal Outcomes After Reducing Postnatal Dexamethasone Use in Infants Born Between 501 and 1250 Grams

PEDIATRICS ◽  
2003 ◽  
Vol 111 (Supplement_E1) ◽  
pp. e534-e541
Author(s):  
Joseph W. Kaempf ◽  
Betty Campbell ◽  
Ronald S. Sklar ◽  
Cindy Arduza ◽  
Robert Gallegos ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Clinical Outcomes ◽  
Airway Pressure ◽  
Neonatal Intensive Care ◽  
Positive Airway Pressure ◽  
Late Onset ◽  
Late Onset Sepsis

Objective. The purpose of this article is to describe how a neonatal intensive care unit (NICU) was able to reduce substantially the use of postnatal dexamethasone in infants born between 501 and 1250 g while at the same time implementing a group of potentially petter practices (PBPs) in an attempt to decrease the incidence and severity of chronic lung disease (CLD). Methods. This study was both a retrospective chart review and an ongoing multicenter evidence-based investigation associated with the Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative (NIC/Q 2000). The NICU specifically made the reduction of CLD and dexamethasone use a priority and thus formulated a list of PBPs that could improve clinical outcomes across 3 time periods: era 1, standard NICU care that antedated the quality improvement project; era 2, gradual implementation of the PBPs; and era 3, full implementation of the PBPs. All infants who had a birth weight between 501 and 1250 g and were admitted to the NICU during the 3 study eras were included (era 1, n = 134; era 2, n = 73; era 3, n = 83). As part of the NIC/Q 2000 process, the NICU implemented 3 primary PBPs to improve clinical outcomes related to pulmonary disease: 1) gentle, low tidal volume resuscitation and ventilation, permissive hypercarbia, increased use of nasal continuous positive airway pressure; 2) decreased use of postnatal dexamethasone; and 3) vitamin A administration. The total dexamethasone use, the incidence of CLD, and the mortality rate were the primary outcomes of interest. Secondary outcomes included the severity of CLD, total ventilator and nasal continuous positive airway pressure days, grades 3 and 4 intracranial hemorrhage, periventricular leukomalacia, stages 3 and 4 retinopathy of prematurity, necrotizing enterocolitis, pneumothorax, length of stay, late-onset sepsis, and pneumonia. Results. The percentage of infants who received dexamethasone during their NICU admission decreased from 49% in era 1 to 22% in era 3. Of those who received dexamethasone, the median number of days of exposure dropped from 23.0 in era 1 to 6.5 in era 3. The median total NICU exposure to dexamethasone in infants who received at least 1 dose declined from 3.5 mg/kg in era 1 to 0.9 mg/kg in era 3. The overall amount of dexamethasone administered per total patient population decreased 85% from era 1 to era 3. CLD was seen in 22% of infants in era 1 and 28% in era 3, a nonsignificant increase. The severity of CLD did not significantly change across the 3 eras, neither did the mortality rate. We observed a significant reduction in the use of mechanical ventilation as well as a decline in the incidence of late-onset sepsis and pneumonia, with no other significant change in morbidities or length of stay. Conclusions. Postnatal dexamethasone use in premature infants born between 501 and 1250 g can be sharply curtailed without a significant worsening in a broad range of clinical outcomes. Although a modest, nonsignificant trend was observed toward a greater number of infants needing supplemental oxygen at 36 weeks’ postmenstrual age, the severity of CLD did not increase, the mortality rate did not rise, length of stay did not increase, and other benefits such as decreased use of mechanical ventilation and fewer episodes of nosocomial infection were documented.

Recurrent late-onset neonatal sepsis traced to breast milk: A case report

2021 ◽  
pp. 1-4
Author(s):  
G. Stepanovich ◽  
S.M. Donn
Keyword(s):  
Breast Milk ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Bacterial Load ◽  
Gi Tract ◽  
Reduction Strategy ◽  
Late Onset Sepsis ◽  
Nutritional Benefits ◽  
Culture Positive ◽  
Milk Feeding

Breast milk feeding is an important late-onset sepsis reduction strategy in the Neonatal Intensive Care Unit (NICU). However, multiple studies have reported transfer of bacteria-contaminated breast milk to infants. We describe a case of culture-positive breast milk resulting in persistent Enterococcus bacteremia in an infant. Beyond the development of an infant’s innate and specific immunity as well as colonization of the gastrointestinal (GI) tract with commensal organisms, the risk of bacterial translocation from the GI tract into the bloodstream is shaped and modified by maternal health, birth history, and an infant’s NICU course. While freezing and/or pasteurizing breast milk reduces or eliminates its bacterial load, it also diminishes its immunologic and nutritional benefits.

scholarly journals Role of Lumbar Puncture in Late Onset Neonatal Sepsis

2019 ◽  
Vol 39 (3) ◽  
pp. 155-161
Author(s):  
Amit Kumar Das ◽  
Deepak Mishra ◽  
Nitu Kumari Jha ◽  
Rakesh Mishra ◽  
Soniya Jha
Keyword(s):  
Blood Culture ◽  
Lumbar Puncture ◽  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Signs And Symptoms ◽  
Clinical Syndrome ◽  
Neonatal Deaths ◽  
Late Onset Sepsis

Introduction: Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection with or without accompanying bacteremia in the first month of life.  It is responsible for about 30-50% of the total neonatal deaths in developing countries.  Neonatal sepsis can be divided into two sub-types depending upon whether the onset of symptoms within the first 72 hours of life (Early Onset Neonatal Sepsis) or after 72 hours of life (Late Onset Neonatal Sepsis ).  Meningitis is an important complication of late onset neonatal sepsis. Method: This was hospital based prospective observational study conducted among the neonates admitted with diagnosis of late onset neonatal sepsis in Neonatal Intermediate Care Unit (NIMCU) and Neonatal Intensive Care Unit (NICU) of Kanti Children’s Hospital from July 2016 to June 2017. The objective of this study was to evaluate the importance of performing LP in neonates with LONS. Results: 16.8% neonates with late onset neonatal sepsis were found to have meningitis. Among the neonates with meningitis CRP was positive 57.2% and negative in 42.8 %.  Among the cases with abnormal CSF findings, blood culture was sterile in 85% cases and organism was isolated 15% cases. In 88.8% cases with positive blood culture, no meningitis was detected. Lumbar puncture was traumatic in 1 neonate (0.8%) in first attempt. Apart from this no other complication of performing lumbar puncture was noted. Conclusion: Lumbar puncture and CSF examination is mandatory in all cases with late-onset sepsis.

Role of N-Terminal Pro-brain Natriuretic Peptide in the Early Diagnosis of Neonatal Sepsis

2019 ◽  
Vol 14 (05) ◽  
pp. 228-234
Author(s):  
Nilufer Okur ◽  
Mehmet Buyuktiryaki ◽  
Nurdan Uras ◽  
Mehmet Yekta Oncel ◽  
Halid Halil ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Newborn Infants ◽  
Diagnostic Biomarker ◽  
Predictive Values ◽  
Mortality And Morbidity ◽  
Late Onset Sepsis

Objective Sepsis is one of the most significant contributors to mortality and morbidity in the neonatal population. The need to find specific biomarkers that provide meaningful information about the diagnosis of sepsis is still ongoing. This study aimed to investigate the utility of N-terminal pro-brain natriuretic peptide (NT-proBNP) as a diagnostic biomarker in newborn infants with late-onset sepsis. Methods A prospective, observational study was conducted in the neonatal intensive care unit between July 2016 and January 2017. The patients suspected of having late-onset sepsis and meeting the selection criteria were included in the study, and serial measurements of white blood cell count, serum C-reactive protein (CRP), plasma interleukin (IL) 6, and whole blood NT-proBNP levels were performed. Results The study included 87 patients diagnosed with sepsis and 35 control patients. The median NT-proBNP levels were higher in septic patients (58 [22–169] vs. 14 [7–21]; p < 0.001), showing a significant correlation with CRP and IL-6 levels (r = 0.327, p < 0.01 and r = 0.216, p < 0.05, respectively). The optimal diagnostic cutoff value for differentiating sepsis was 27.5 pg/mL. Predictive parameters of NT-proBNP, such as sensitivity (72%) and specificity (86%), were comparable to those of CRP and IL-6 for the early diagnosis of sepsis in neonates. Conclusion Plasma NT-proBNP levels were higher in septic neonates, and the predictive values were comparable to those of CRP and IL-6. However, these values were not high enough to make it a reliable diagnostic biomarker for identifying neonates in the early stages of sepsis.

scholarly journals QUALITATIVE REVIEW OF ANTIBIOTIC USE FOR NEONATAL SEPSIS

2018 ◽  
Vol 10 (1) ◽  
pp. 364
Author(s):  
Tjio Ie Wei ◽  
Purwantyastuti Ascobat ◽  
Rinawati Rohsiswatmo ◽  
Insti Instiaty
Keyword(s):  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Antibiotic Use ◽  
Klebsiella Pneumonia ◽  
First Line ◽  
Normal Birth ◽  
Late Onset Sepsis ◽  
Sensitivity Tests ◽  
Blood Specimens

Objective: The aim of this study is to evaluate the antibiotic use in neonates with sepsis.Methods: An observational retrospective study was conducted using medical records of neonates diagnosed with early-/late-onset sepsis who wereprescribed antibiotics and who were treated in the neonatal intensive care unit (NICU) at the Dr. Cipto Mangunkusumo Hospital between January 1 andDecember 31, 2015. Patient records were screened for antibiotic use; qualitative analyses were performed using the Gyssens algorithm. Concordanceof empirical antibiotic prescriptions with subsequent blood culture and sensitivity tests was evaluated.Results: A total of 176 sepsis cases included 80 and 96 neonates with normal and low birth weights (LBWs), respectively. Ampicillinsulbactam+gentamycin, which is indicated in local guidelines as the first-line antibiotic combination for neonatal sepsis, was most frequentlyprescribed. In the normal birth weight group, appropriate antibiotic use (Gyssens Category I) was found in 89.7% of cases, whereas Gyssens Category V(no indication) was found in 4.54% of cases. In the LBW group, 88.1% and 6.2% of cases were included in Gyssens Categories I and V, respectively.Only 17.5% and 13.5% cultured blood specimens from normal and LBW groups, respectively, yielded positive results; the most commonly identifiedbacteria were Acinetobacter baumannii and Klebsiella pneumonia. All isolates were resistant to ampicillin-sulbactam; only 7.4% were sensitive togentamicin.Conclusion: Antibiotic use for neonatal sepsis in NICU in this study can be considered appropriate, suggesting proper implementation of antimicrobialguidelines. However, high rates of resistance to the first-line antibiotics for neonatal sepsis are concerning.

scholarly journals Severe sepsis and retinopathy of prematurity in very low birth weight preterm newborns in a third-level healthcare center in Lima, Peru between 2008 and 2018: A case-control study

Medwave ◽  
2021 ◽  
Vol 21 (03) ◽  
pp. e8157-e8157
Author(s):  
Alvaro Valdivia ◽  
Daniela Bullard Elias ◽  
Cecilia Herbozo ◽  
German Málaga
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Retinopathy Of Prematurity ◽  
Odds Ratio ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Late Onset ◽  
Case Control ◽  
Late Onset Sepsis

Background Retinopathy of prematurity is the leading worldwide cause of visual impairment. There is little available data on its epidemiology and related factors and consequences in developing countries such as Peru. Due to this lack of information, we decided to do this study. Objectives To evaluate factors related to the development of retinopathy of prematurity in very low birth weight newborn patients. Methods We did a case-control (paired 1:1) study of patients admitted to the Neonatal Intensive Care Unit of the Hospital Cayetano Heredia between 2008 and 2018 who had a complete record in the Neocosur network database (N = 293). The case was defined as a preterm newborn patient with a birth weight lower than 1500 grams who developed any type or stage of retinopathy of prematurity; control was defined as a patient with similar characteristics without retinopathy. Univariate and bivariate analysis (using logistic regression model) was performed to obtain the odds ratio with a 95% confidence interval. Results Data were obtained from 57 cases and 57 controls admitted to the Neonatal Intensive Care Unit at Hospital Cayetano Heredia. Late-onset sepsis was the main factor associated with retinopathy of prematurity (odds ratio 4.39; 95% confidence interval 1.23 to 15.76, p = 0.02). Additionally, we performed a bivariate and multivariate analysis that showed that exposure to supplementary oxygen at 36 weeks of postmenstrual age and retinopathy of prematurity were not significantly associated (8.47; 0.51 to 141.17, p = 0.14). Conclusions Patients with late-onset sepsis have a 4.39 times higher odds of developing retinopathy of prematurity. Prospective studies are needed with larger sample sizes.

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