Time to Positivity of Blood Cultures Could Inform Decisions on Antibiotics Administration in Neonatal Early-Onset Sepsis

(1) Background: Empirical antibiotics for suspected neonatal early-onset sepsis are often prolonged administered, even in the absence of clinical signs of infection, while awaiting the blood cultures results. The C-reactive protein is widely used to guide antibiotic therapy, although its increase in the first hours of life is not always evidence of infection. The aim of this study was to evaluate the time to positivity (TTP) of blood cultures (BC) that develop pathogens in our population of neonates and determine whether TTP could safely inform the decisions on empirical antibiotic discontinuation in neonatal early-onset sepsis and reduce the use of unnecessary antibiotics. (2) Methods: We retrospectively collected data of all newborns ≥ 34 weeks admitted to the Neonatal Intermediate-Care Unit at Policlinico “A. Gemelli” University Hospital (Rome, Italy) from 2014 to 2018, with suspected early-onset sepsis (EOS). The TTP was the time in hours from the first BC inoculation to the bacterial growth. We defined as positive BC only those with a pathogenic organism. (3) Results: In total, 103 out of 20,528 infants born in the five-year study period were admitted to our Neonatal Intermediate-Care Unit because of a suspected EOS and enrolled into the study. The mean TTP of pathogenic organisms was 17.7 ± 12.5 h versus 80.5 ± 55.8 h of contaminants (p = 0.003). We found ten positive BCs. The TTP of BC was lower than 12, 36, and 48 h in 80%, 90%, and 100% of cases, respectively. CRP levels on admission were similar in infants with a positive and negative BC (p = 0.067). The discontinuation of therapy in asymptomatic infants 48 h after initiation would have resulted in a saving of 217 days of antibiotics (31.1% of total days administered). (4) Conclusion: From our data, the TTP of blood cultures that develop pathogens is less than 48 h in 100% of cases. Therefore, in late preterm and full-term infants with suspected EOS, stopping empiric antibiotics 48 h after initiation may be a safe practice to reduce unnecessary antibiotic use, when blood cultures are negative and infants asymptomatic.

Download Full-text

Early-Onset Neonatal Sepsis and Antibiotic Use in Northeast Thailand

American Journal of Perinatology ◽

10.1055/s-0038-1676829 ◽

2018 ◽

Vol 36 (12) ◽

pp. 1295-1303

Author(s):

Pakaphan Kiatchoosakun ◽

Junya Jirapradittha ◽

Prapassara Sirikarn ◽

Malinee Laopaiboon ◽

Porjai Pattanittum ◽

...

Keyword(s):

Early Onset ◽

Neonatal Intensive Care ◽

Clinical Symptoms ◽

Clinical Signs ◽

Antibiotic Use ◽

Adverse Outcomes ◽

High Rate ◽

Northeast Thailand ◽

Suspected Sepsis ◽

Early Onset Sepsis

Objective Antibiotics are commonly prescribed in neonatal intensive care units (NICUs) for suspected sepsis because of the nonspecific clinical symptoms of sepsis. The overuse of antibiotic is associated with adverse outcomes. This study aimed to determine the rate of early-onset sepsis (EOS) and antibiotic use in neonates admitted to three NICUs in Northeast Thailand Study Design This is a descriptive study using the data collected in the South East Asia—Using Research for Change in Hospital-acquired Infection in Neonates project. Neonates admitted within 3 days of life were included. EOS was defined as neonates who presented with three or more clinical signs or laboratory results suggested sepsis and received antibiotics for at least 5 days. Those with positive blood culture were culture-proven EOS. Antibiotic use within 3 days of life and up to 28 days was described. Results Among 1,897 neonates, 160 cases were classified as EOS (8.4%) with culture-proven EOS in 4 cases (0.2%). The median durations of antibiotic use in culture-proven and culture-negative EOSs were 15 and 8 days, respectively. Conclusion The rate of culture-proven EOS was low, but there was a high rate of antibiotic use. Antibiotic stewardship should be emphasized.

Download Full-text

Time to Positivity of Neonatal Blood Cultures for Early-onset Sepsis

The Pediatric Infectious Disease Journal ◽

10.1097/inf.0000000000002632 ◽

2020 ◽

Vol 39 (7) ◽

pp. 634-640

Author(s):

Michael W. Kuzniewicz ◽

Sagori Mukhopadhyay ◽

Sherian Li ◽

Eileen M. Walsh ◽

Karen M. Puopolo

Keyword(s):

Early Onset ◽

Blood Cultures ◽

Time To Positivity ◽

Early Onset Sepsis ◽

Neonatal Blood

Download Full-text

1173 Does transport time to offsite microbiology affect time to positivity of blood cultures in infants screened for early onset sepsis?

10.1136/archdischild-2021-rcpch.451 ◽

2021 ◽

Author(s):

Edward Donald James Broad

Keyword(s):

Early Onset ◽

Blood Cultures ◽

Transport Time ◽

Time To Positivity ◽

Early Onset Sepsis

Download Full-text

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

American Journal of Perinatology ◽

10.1055/s-0037-1607420 ◽

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.

Download Full-text

Comparison of institutional guidelines with established early onset sepsis risk calculator in reducing antibiotic use in an inner-city NICU in US

Journal of Global Antimicrobial Resistance ◽

10.1016/j.jgar.2020.03.015 ◽

2020 ◽

Vol 21 ◽

pp. 124-129

Author(s):

Ezer H. Benaim ◽

Kirtikumar Upadhyay ◽

Ajay J. Talati

Keyword(s):

Inner City ◽

Early Onset ◽

Antibiotic Use ◽

Risk Calculator ◽

Early Onset Sepsis ◽

Sepsis Risk

Download Full-text

Relevance of Biomarkers Currently in Use or Research for Practical Diagnosis Approach of Neonatal Early-Onset Sepsis

Children ◽

10.3390/children7120309 ◽

2020 ◽

Vol 7 (12) ◽

pp. 309

Author(s):

Maura-Adelina Hincu ◽

Gabriela-Ildiko Zonda ◽

Gabriela Dumitrita Stanciu ◽

Dragos Nemescu ◽

Luminita Paduraru

Keyword(s):

High Mortality ◽

Early Onset ◽

Clinical Signs ◽

Developed Countries ◽

Extremely Low Birth Weight ◽

Invasive Infection ◽

Acute Phase Reactants ◽

Hematological Indices ◽

Live Births ◽

Early Onset Sepsis

Neonatal early-onset sepsis (EOS) is defined as an invasive infection that occurs in the first 72 h of life. The incidence of EOS varies from 0.5–2% live births in developed countries, up to 9.8% live births in low resource settings, generating a high mortality rate, especially in extremely low birth weight neonates. Clinical signs are nonspecific, leading to a late diagnosis and high mortality. Currently, there are several markers used for sepsis evaluation, such as hematological indices, acute phase reactants, cytokines, which by themselves do not show acceptable sensitivity and specificity for the diagnosis of EOS in neonates. Newer and more selective markers have surfaced recently, such as presepsin and endocan, but they are currently only in the experimental research stages. This comprehensive review article is based on the role of biomarkers currently in use or in the research phase from a basic, translational, and clinical viewpoint that helps us to improve the quality of neonatal early-onset sepsis diagnosis and management.

Download Full-text

The Use of Blood Counts and Blood Cultures to Screen Neonates Born to Partially Treated Group B Streptococcus-carrier Mothers for Early-onset Sepsis

The Pediatric Infectious Disease Journal ◽

10.1097/inf.0b013e3182223586 ◽

2011 ◽

Vol 30 (10) ◽

pp. 840-843 ◽

Cited By ~ 16

Author(s):

Saar Hashavya ◽

Shmuel Benenson ◽

Zivanit Ergaz-Shaltiel ◽

Benjamin Bar-Oz ◽

Diana Averbuch ◽

...

Keyword(s):

Early Onset ◽

Group B Streptococcus ◽

Treated Group ◽

Blood Cultures ◽

Early Onset Sepsis ◽

Group B

Download Full-text

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

Clinical Pediatrics ◽

10.1177/0009922817751337 ◽

2017 ◽

Vol 57 (9) ◽

pp. 1080-1085 ◽

Cited By ~ 17

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.

Download Full-text

Early-Onset Sepsis Risk Calculator: A Review Of Its Effectiveness And Comparative Study With Our Evidence-Based Local Guidelines

10.21203/rs.3.rs-136483/v1 ◽

2021 ◽

Author(s):

Gianluigi Laccetta ◽

Massimiliano Ciantelli ◽

Cristina Tuoni ◽

Emilio Sigali ◽

Mario Miccoli ◽

...

Keyword(s):

Gestational Age ◽

Early Onset ◽

Clinical Signs ◽

Risk Calculator ◽

Live Births ◽

Early Onset Sepsis ◽

Number Of Patients ◽

Sepsis Risk ◽

Empirical Antibiotics ◽

Sepsis Calculator

Abstract Background According to most early-onset sepsis management guidelines, approximately 10% of the total neonatal population are exposed to antibiotics in the first postnatal days with subsequent increase of neonatal and pediatric comorbidities. Early-onset sepsis risk calculator has been developed with the purpose of avoiding antibiotic overtreatment among neonates ≥ 34 weeks’ gestational age: a review of literature demonstrates its effectiveness in reducing antibiotic overtreatment, laboratory testing, painful procedures and NICU admission; however, some missed cases of culture-positive early-onset sepsis have also been described. Methods All neonates with birth weight ≤ 1500 g, 34–36 weeks’ gestational age neonates with suspected intraamniotic infection and neonates with three clinical signs of early-onset sepsis or two signs and one risk factor for early-onset sepsis receive empirical antibiotics. Neonates ≥ 34 weeks’ gestational age with risk factors for early-onset sepsis or with one clinical indicator of early-onset sepsis undergo serial measurements of C-reactive protein and procalcitonin in the first 48–72 hours of life; they receive empirical antibiotics in case of abnormalities at blood exams with one or more clinical signs of early-onset sepsis. We therefore compared the number of patients for which antibiotics were needed, based on early-onset sepsis calculator, and the number of patients we treated with antibiotics during the study period. Comparisons between the groups were performed using McNemar’s test and statistical significance was set at p < 0.05. Results During the study period (1st January 2018-31st December 2018) 32/265 (12.1%) neonates ≥ 34 weeks’ gestational age at risk for early-onset sepsis received antibiotics within the first 12 hours of life. According to early-onset sepsis calculator: 55/265 (20.7%) patients would have received antibiotics with early-onset sepsis incidence 2/1000 live births (p < 0.0001); 44/265 (16.6%) patients would have received antibiotics with early-onset sepsis incidence 0.1/1000 live births (p < 0.025). One patient with culture-negative early-onset sepsis would not have received antibiotics with an early-onset sepsis incidence of 0.1/1000 live births. Conclusion Our evidence-based protocol for treatment decision-making of neonatal early-onset sepsis entails a further decrease of antibiotic overtreatment compared to early-onset sepsis risk calculator. No negative consequences for patients were observed.

Download Full-text