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Duration of Empiric Antibiotics for Suspected Early-Onset Sepsis in Extremely Low Birth Weight Infants

Published online by Cambridge University Press:  02 January 2015

Leandro Cordero  and
Leona W. Ayers
Leandro Cordero*
Affiliation:
Division of Neonatal-Perinatal Medicine and the Departments of Pediatrics and Obstetrics, The Ohio State University College of Medicine, Columbus, Ohio
Leona W. Ayers
Affiliation:
Departments of Pathology and Allied Medical Professions, The Ohio State University College of Medicine, Columbus, Ohio
*
The Ohio State University Medical Center, Pediatrics Department, N-118 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210-1228
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Abstract

Objectives:

To study multicenter antibiotic practices for suspected early-onset sepsis (EOS) with negative blood cultures (NegBCs) and to identify opportunities for reduction of antimicrobial exposure.

Design:

Retrospective study.

Setting:

Thirty academic hospitals (University HealthSystem Consortium) located in 24 states.

Methods:

Data were from a survey of 790 extremely low birth weight (ELBW) infants. Total antibiotic exposures (antibiotic-days per patient) were calculated.

Results:

On admission to the NICU, 94% of 790 ELBW infants had BCs performed and empiric antibiotics initiated. When PosBC and NegBC infants were compared, 47 patients with PosBCs were similar to 695 with NegBCs in birth weight, gestational age (GA), and mortality. Patients with suspected EOS but NegBCs given ampicillin/aminoglycosides were grouped by length of administration and GA. For GA of 26 weeks or younger, 170 infants given a short (≤ 3 days) and 157 given a long (≥ 7 days) course were similar regarding birth weight, mortality, antepartum history, and CRIB scores, but were different (P < .01) in number receiving a third antimicrobial (3% and 17%) and antibiotic-days (23 and 38). For GA of 27 weeks or older, 113 infants given a short and 77 given a long course differed (P < .01) in number receiving a third antimicrobial (2% and 23%) and antibiotic-days (19 and 30).

Conclusions:

Most suspected EOS infants with NegBCs are given antibiotics, but no antepartum historical risk factors or neonatal clinical signs explained prolonged administration. Discontinuing empiric antibiotics when BCs are negative in asymptomatic ELBW infants can reduce antimicrobial exposure without compromising clinical outcome.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 9 , September 2003 , pp. 662 - 666
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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References

1.The Committee on Infectious Diseases and Committee on Fetus and Newborn. Revised guidelines for prevention of early-onset Group B streptococcal (GBS) infection. Pediatrics 1997;99:489–496.Google Scholar
2.Stoll, BJ, Gordon, T, Korones, SB, et al.Early-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr 1996;129:72–80.CrossRefGoogle ScholarPubMed
3.Kaftan, H, Kinney, JS. Early onset neonatal bacterial infections. Semin Perinatal 1998;22:15–24.CrossRefGoogle ScholarPubMed
4.Cordero, L, Sananes, M, Ayers, LW. Bloodstream infections in a neonatal intensive-care unit: 12 years' experience with an antibiotic control program. Infect Control Hosp Epidemiol 1999;20:242–246.Google Scholar
5.Saez-Llorens, X, McCracken, GH Jr. Perinatal bacterial diseases. In: Feigin, RD, Cherry, JD, eds. Textbook of Pediatric Infectious Diseases. Philadelphia: W. B. Saunders; 1998:892.Google Scholar
6.Shlaes, DO, Gerding, DN, John, JF, et al.Society for Healthcare Epidemiology of America and Infectious Diseases Society of American Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Infect Control Hosp Epidemiol 1997;18:275–291.Google Scholar
7.Bennet, R, Eriksson, M, Nord, C-E, Zetterstrom, R. Fecal bacterial microflora of newborn infants during intensive care management and treatment with five antibiotic regimens. Pediatr Infect Dis 1986;5:533–539.Google Scholar
8.Moore, DL. Nosocomial infections in newborn nurseries and neonatal intensive care units. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore: Williams and Wilkins; 1996:535–564.Google Scholar
9.Goldmann, DAWeinstein, MA, Wenzel, RP, et al.Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals. JAMA 1996;275:234–240.Google Scholar
10.Namias, N, Harvill, S, Ball, S, McKenney, MG, Salomone, JP, Civetta, JM. Cost and morbidity associated with antibiotic prophylaxis in the ICU. J Am Coll Surg 1999;188:225–230.CrossRefGoogle ScholarPubMed
11.De Courcy-Wheeler, RHB, Wolfe, CDAFitzgerald, ASpencer, M, Goodman, JDS, Gamsu, HR. Use of the CRIB (clinical risk index for babies) score in prediction of neonatal mortality and morbidity. Arch Dis Child Fetal Neonatal Ed 1995;73:F32–F36.CrossRefGoogle ScholarPubMed
12.Kaaresen, PI, Dohlen, G, Fundingsrud, HP, Dahl, LB. The use of CRIB (clinical risk index for babies) score in auditing the performance of one neonatal intensive care unit. Acta Paediatr 1998;87:195–200.Google Scholar
13.Horns, KM. Neoteric physiologic and immunologic methods for assessing early-onset neonatal sepsis. Journal of Perinatal Neonatal Nursing 2000;13:50–66.Google Scholar
14.Thureen, PJ, Moreland, S, Rodden, DJ, Merenstein, GB, Levin, M, Rosenberg, M. Failure of tracheal aspirate cultures to define the cause of respiratory deteriorations in neonates. Pediatr Infect Dis J 1993;12:560–564.Google Scholar
15.Koenig, JM, Christensen, RD. Incidence, neutrophil kinetics, and natural history of neonatal neutropenia associated with maternal hypertension. N Engl J Med 1989;321:557–562.Google Scholar
16.Cordero, L, Samuels, P, Hillman, T. Neutropenia in infants born to women with severe preeclampsia. Prenatal and Neonatal Medicine 1996;1:363–370.Google Scholar
17.Fischer, JE, Ramser, M, Fanconi, S. Use of antibiotics in pediatric intensive care and potential savings. Intensive Care Med 2000;26:959–966.Google Scholar
18.Goldmann, DA, Leclair, J. Macone A. Bacterial colonization of neonates admitted to an intensive care environment. Pediatrics 1978;93:288–293.Google Scholar
19.Lesko, SM, Epstein, ME, Mitchell, AA. Recent patterns of drug use in newborn intensive care. J Pediatr 1990;116:985–990.Google Scholar
20.Pauli, I Jr, Shekiawat, P, Kehl, S, Sasidharan, P. Early detection of bacteremia in the neonatal intensive care unit using the new BACTEC system. J Perinatal 1999;19:127–131.CrossRefGoogle ScholarPubMed
21.Garcia-Prats, JACooper, TR, Schneider, VF, Stager, CE, Hansen, TN. Rapid detection of microorganisms in blood cultures of newborn infants utilizing an automated blood culture system. Pediatrics 2000;105:52–57.Google Scholar
22.Kumar, Y, Qunibi, M, Neal, TJ, Yoxall, CW. Time to positivity of neonatal blood cultures. Arch Dis Child Fetal Neonatal Ed 2001;85:F182–F186.Google Scholar