Does Maternal Intrapartum Antibiotic Treatment Prolong the Incubation Time Required for Blood Cultures to Become Positive for Infants with Early-Onset Sepsis?

Sarkar, Siddhartha; Bhagat, Indira; Bhatt‐Mehta, Varsha; Sarkar, Subrata

doi:10.1055/s-0034-1387933

Cited by 14 publications

(5 citation statements)

References 12 publications

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“…While we cannot make any conclusions regarding “false negative” blood culture, we did not find any difference in TTP between infants born to women who did or did receive intrapartum antibiotics. Similar results have been noted in other reports that primarily include term infants (37, 41). The findings of this study suggest neonatal clinicians can begin to consider discontinuing empiric antibiotics among VLBW infants with sterile cultures at 36–48 hours of incubation.…”

Section: Discussionsupporting

confidence: 91%

Clinical and Microbiologic Characteristics of Early-onset Sepsis Among Very Low Birth Weight Infants

Mukhopadhyay

Puopolo²

2017

Pediatric Infectious Disease Journal

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Background Most very-low birth weight (birth weight <1500 grams, VLBW) infants receive empiric antibiotics for risk of early-onset sepsis (EOS). The objective of this study was to determine the characteristics of VLBW infants with culture-confirmed EOS at a single center during 25 years, to identify opportunities for antibiotic stewardship. Methods Retrospective cohort study including VLBW infants admitted from 1990–2015. EOS was defined as isolation of a pathogen in blood or cerebrospinal fluid culture obtained < 72 hours of age. Clinical and microbiologic characteristics of EOS case infants were obtained by review of medical, laboratory and administrative records. Blood culture, antibiotic initiation, and maternal discharge code data was available for all VLBW infants born 1999–2013. Result 109 EOS cases (20.5/1000 VLBW births) occurred during the study period. Preterm labor, preterm rupture of membranes and/or the obstetrical diagnosis of chorioamnionitis were present in 106/109 cases (97%). Obligate anaerobic organisms accounted for 16% of cases. Time to culture positivity was 36 hours for 88% and 48 hours for 98% of cases. From 1999–2013, 97% of VLBW infants were evaluated for EOS and 90% administered empiric antibiotics; 22% of these infants were born by Cesarean section to mothers with pre-eclampsia and without preterm labor or chorioamnionitis and had a 12-fold lower incidence of EOS compared to the remaining infants. Conclusion Decisions to initiate and discontinue empiric antibiotics among VLBW infants can be informed by the delivery characteristics of infected infants, and by local microbiologic data.

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Section: Discussionsupporting

confidence: 91%

Clinical and Microbiologic Characteristics of Early-onset Sepsis Among Very Low Birth Weight Infants

Mukhopadhyay

Puopolo²

2017

Pediatric Infectious Disease Journal

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“…For GBS and E. coli around 96–100% are positive by 36 h ( 85 , 86 , 89 ), whereas coagulase negative staphylococci may take up to 48 h to be detected. Maternal intrapartum antibiotic therapy does not seem to delay TTP ( 85 , 90 ). Thus, considering TTP aids in clinical interpretation of blood culture results and is the reason why central guidelines suggest stopping antibiotics if culture results are negative at 36–48 h ( 8 , 31 ).…”

Section: Antimicrobial Stewardship In the Neonatal Unitmentioning

confidence: 99%

Culture-Negative Early-Onset Neonatal Sepsis — At the Crossroad Between Efficient Sepsis Care and Antimicrobial Stewardship

et al. 2018

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Sepsis is a leading cause of mortality and morbidity in neonates. Presenting clinical symptoms are unspecific. Sensitivity and positive predictive value of biomarkers at onset of symptoms are suboptimal. Clinical suspicion therefore frequently leads to empirical antibiotic therapy in uninfected infants. The incidence of culture confirmed early-onset sepsis is rather low, around 0.4–0.8/1000 term infants in high-income countries. Six to 16 times more infants receive therapy for culture-negative sepsis in the absence of a positive blood culture. Thus, culture-negative sepsis contributes to high antibiotic consumption in neonatal units. Antibiotics may be life-saving for the few infants who are truly infected. However, overuse of broad-spectrum antibiotics increases colonization with antibiotic resistant bacteria. Antibiotic therapy also induces perturbations of the non-resilient early life microbiota with potentially long lasting negative impact on the individual‘s own health. Currently there is no uniform consensus definition for neonatal sepsis. This leads to variations in management. Two factors may reduce the number of culture-negative sepsis cases. First, obtaining adequate blood cultures (0.5–1 mL) at symptom onset is mandatory. Unless there is a strong clinical or biochemical indication to prolong antibiotics physician need to trust the culture results and to stop antibiotics for suspected sepsis within 36–48 h. Secondly, an international robust and pragmatic neonatal sepsis definition is urgently needed. Neonatal sepsis is a dynamic condition. Rigorous evaluation of clinical symptoms (“organ dysfunction”) over 36–48 h in combination with appropriately selected biomarkers (“dysregulated host response”) may be used to support or refute a sepsis diagnosis.

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“…For group B streptococcus and E. coli, 96% up to 100% of cultures are positive by 36 h [42,43,45]. On the other hand, for coagulase negative staphylococci, which are almost always a contaminant, TTP can be as long as 48 h [42,46].…”

Section: Biomarkers Commonly Used or Under Consideration For Eos Diagnosis In Neonatesmentioning

confidence: 99%

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

et al. 2020

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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.

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Does Maternal Intrapartum Antibiotic Treatment Prolong the Incubation Time Required for Blood Cultures to Become Positive for Infants with Early-Onset Sepsis?

Abstract: Maternal intrapartum antibiotic treatment did not delay the time to blood culture positivity in infants with EOS.

Cited by 14 publications

References 12 publications

Clinical and Microbiologic Characteristics of Early-onset Sepsis Among Very Low Birth Weight Infants

Clinical and Microbiologic Characteristics of Early-onset Sepsis Among Very Low Birth Weight Infants

Culture-Negative Early-Onset Neonatal Sepsis — At the Crossroad Between Efficient Sepsis Care and Antimicrobial Stewardship

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

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