Secondary prevention of early-onset sepsis: a less invasive Italian approach for managing neonates at risk

Berardi, Alberto; Tzialla, Chryssoula; Bua, Jenny; Santori, Daniele; Azzalli, Milena; Spada, C.; Lucaccioni, Laura

doi:10.1186/s13052-018-0515-8

Cited by 7 publications

(9 citation statements)

References 14 publications

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“…It should be mentioned that there are new strategies to detect the threat of EOS, regardless of its etiology, on the basis of serial physical examinations, however, this approach cannot be regarded as preventive. These strategies are implemented in NICUs to reduce laboratory costs and to limit overuse of antibiotics [50,51]. The most commonly used among these strategies are related to antibiotic stewardship principles adopted in many NICUs, sometimes under pressure from global campaigns for the prudent use of antibiotics promoted by international and national organizations such as the World Health Organization (WHO), the Infectious Diseases Society of America, the CDC, and the ECDC.…”

Section: Resultsmentioning

confidence: 99%

Neonate Bloodstream Infections in Organization for Economic Cooperation and Development Countries: An Update on Epidemiology and Prevention

Wójkowska‐Mach

Chmielarczyk

Strus

et al. 2019

JCM

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The term neonatal sepsis is used to describe a generalized bloodstream infection of bacterial, viral, or fungal origin which is associated with hemodynamic changes and other clinical symptoms and signs, however, there is no unified definition. There are no basic criteria regarding differentiation of early-onset sepsis (EOS) versus late-onset sepsis (LOS). Stratification used in studies on neonatal sepsis also rarely includes the general condition of the newborn according to unambiguous assessment at birth, which hampers the establishment of a clear, uniform epidemiological description of neonatal sepsis. We aim to review the published data about the epidemiology and microbiology of sepsis in Organization for Economic Cooperation and Development (OECD) countries. Data was also collected on sepsis prevention programs that can be implemented in neonatal units. The outcomes of interest were incidence or incidence density of EOS and LOS, microbiology of EOS and LOS, and data on the methodology of the research, in particular the criteria for inclusion and exclusion of newborns from the study. Pubmed, EMBASE, LILACS Embase, Scopus, and Google Scholar were used. For the preselection step, inclusion criteria included: “bloodstream infection” or “neonatal sepsis” (MesH), “very low birth weight”, and “country” full-text studies, human, and English language. Exclusion criteria included: studies published in languages other than English and studies available only as an abstracts. For proper selection, inclusion criteria included: information about epidemiology or microbiology bloodstream infection (BSI), study population and case definitions, exclusion criteria, narrative reviews, commentaries, case studies, pilot studies, study protocols, pediatric studies, and only clinical data (without microbiology or epidemiology) or studies with only one etiological factor analysis. The data review indicated the lack of an unequivocal, unified definition and no unambiguous basic criteria with regard to differentiation of EOS versus LOS. Among infants <1500 g, studies reported an EOS rate from 7% to 2%. For studies using other definitions (mostly all inborn babies), the rate of EOS ranged from 1% to 3%. The LOS incidences were much more varied among countries; the highest rates were in the multicenter studies focused on very low birth weight (VLBW) infants. The main pathogens in EOS are GBS and Gram-negative bacteria in LOS. Our review data shows that LOS microbiology is very diverse and that Gram-positive cocci, especially staphylococci, predominate versus Gram-negative rods. Unfortunately, the lack of uniform, international prevention programs results in high newborn morbidity and insufficient postnatal prevention of late-onset infections.

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Section: Resultsmentioning

confidence: 99%

Neonate Bloodstream Infections in Organization for Economic Cooperation and Development Countries: An Update on Epidemiology and Prevention

Wójkowska‐Mach

Chmielarczyk

Strus

et al. 2019

JCM

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“…In the present study, healthcare-associated infection (HCAI) was defined as follows: (1) infection that was not present or incubated at the time of hospital admission; (2) infection related to hospital procedures; (3) infection that the newborn acquires as a result of passing through the birth canal or contact with surgical instrument; and (4) infection occurring in the 30 days following the intervention. Infections that did not meet these criteria were considered to be community acquired [ 3 ].…”

Section: Methodsmentioning

confidence: 99%

“…The postnatal period is risky for the multiple opportunities of exposure to pathogenic microorganisms. Prematurity, low birth weight, exposure to invasive procedures, receiving parenteral nutrition with lipid emulsions, alterations in the skin and/or mucous membrane barriers, frequent use of broad-spectrum antibiotics and prolonged hospital stay are the most common risk factors for infections in newborns [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…According to estimates by the World Health Organization (WHO) in 2017, 46% of deaths in children under fiveyears occurred in newborns, with infections being ranked as the second direct cause of death [ 3 ]. The rates of neonatal infection vary depending on geographic region, economic resources, access to health andmaternal and fetal risks.…”

Section: Introductionmentioning

confidence: 99%

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Characterization of Neonatal Infections by Gram-Negative Bacilli and Associated Risk Factors, Havana, Cuba

Oliva¹,

Carmona

López

et al. 2021

Infectious Disease Reports

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Infections represent an important problem in neonates because of the high mortality. An increase in neonatal infections has been found in Cuban hospitals in recent years. The aim of this study was to provide evidence on the clinical and microbiological behavior of Gram-negative bacilli that cause neonatal infections in hospitals of Havana, Cuba. It was carried out as a descriptive cross-sectional investigation from September 2017 to July 2018 in The Tropical Medicine Institute “Pedro Kouri” (IPK). Sixty-one Gram-negative bacilli isolated from neonates with infections in six Gyneco-Obstetric and Pediatric Hospitals of Havana were analyzed for their species and antimicrobial susceptibility. Late-onset infections were more common than early-onset ones and included urinary tract infection in the community (87%) and sepsis in hospitals (63.3%). Catheter use (47%) and prolonged stay (38%) were the most frequent risk factors. Species of major pathogens were Escherichia coli (47%) and Klebsiella spp. (26%). The isolated Gram-negative bacilli showed high resistance rates to third-generation cephalosporins, ciprofloxacin and gentamicin, while being more susceptible to carbapenems, fosfomycin, colistin and amikacin. The present study revealed the clinical impact of Gram-negative bacilli in neonatology units in hospitals of Havana. Evaluation of antimicrobial susceptibilities to the isolates from neonates is necessary for selection of appropriate empirical therapy and promotion of the rational antibiotic use.

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“…The second approach is clinical monitoring of at-risk infants in the hospital for a period (usually 48 hours) after birth with intervention (diagnostic testing for sepsis and treating) if clinical signs of sepsis become apparent. 4,5 With clinical monitoring, the theoretical advantages are that every at-risk infant is closely evaluated (thereby eliminating the risk of falsenegatives) and the cost and pain of blood sampling, insertion of intravenous catheters, and antibiotic administration are avoided in a certain number of patients (ie, in the false-positives). However, clinical monitoring requires more time and effort on the part of the nurses and clinicians performing the monitoring (a particular challenge in resource-poor settings), requires skilled personnel, may cause separation of the infant and mother if the monitoring occurs in the NICU, and only leads to treatment of infants after they demonstrate clinical signs (and not preemptive treatment before clinical presentation).…”

mentioning

confidence: 99%

Management of Late-Preterm and Term Neonates at Risk for Early-Onset Sepsis

Suresh

Pammi

2019

Hospital Pediatrics

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The management of patients at risk for a low-frequency but serious illness poses many challenges for health professionals. Neonatal early-onset sepsis (EOS) in late-preterm and term neonates is a classic example of such a low-frequency serious condition. Faced with the possibility that such an infant, even if well appearing, can develop EOS, clinicians have traditionally erred on the side of treating with antibiotics until the EOS is ruled out by some combination of a continued normal clinical examination, negative blood cultures, and negative rapid diagnostic test results. A liberal antibiotic treatment strategy resulted in a large number (as high as several hundreds) of infants being needlessly treated with antibiotics for every neonate with true EOS. This strategy has been relatively easy for clinicians to follow because the burden of administering a short course of antibiotics is relatively low, and the adverse effects of antibiotics (eg, emergence of antibiotic resistance, altered microbiome) are not immediately apparent or dramatic. In contrast, most clinicians have experienced in their careers or heard about newborn infants with catastrophic consequences or even death from EOS, especially during an era when group B streptococcal infection was more common than today. Thus, there was significant overtreatment of infants as well as much interinstitutional and interclinician variation in the frequency of antibiotic use for neonates at risk for EOS. In recent years, this calculus of weighing of a possible catastrophic event that occurs at low frequency against the invisible and delayed hazards of antibiotics has changed. Nationally and internationally, alarms are being raised about the hazards of antibiotics, the widespread emergence of bacterial resistance to antibiotics, and the drying up of the pipeline of new antibiotics. This has led to the emergence of approaches designed to better identify and target infants at risk for EOS to avoid needless antibiotic therapy. Two such broad approaches (which can be complementary and are not mutually exclusive) have emerged for the management of well-appearing late-preterm or term newborns at risk for EOS.The first approach is prospective risk categorization by using a combination of maternal and infant clinical and laboratory variables soon after birth, followed by actions directed by the level of risk (diagnostic testing for sepsis and treating if the probability of sepsis exceeds the test threshold and treatment threshold, respectively). Risk categorization can be performed with multivariate statistical models, an example of which is a Web-based EOS risk calculator, 1 or by using criteria and algorithms based on a combination of published evidence and expert judgment. 2 In theory, the advantages of prospective risk stratification are that antibiotic therapy can be initiated before the

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Secondary prevention of early-onset sepsis: a less invasive Italian approach for managing neonates at risk

Cited by 7 publications

References 14 publications

Neonate Bloodstream Infections in Organization for Economic Cooperation and Development Countries: An Update on Epidemiology and Prevention

Neonate Bloodstream Infections in Organization for Economic Cooperation and Development Countries: An Update on Epidemiology and Prevention

Characterization of Neonatal Infections by Gram-Negative Bacilli and Associated Risk Factors, Havana, Cuba

Management of Late-Preterm and Term Neonates at Risk for Early-Onset Sepsis

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