Should Antibiotics be Discontinued at 48 Hours for Negative Late-Onset Sepsis Evaluations in the Neonatal Intensive Care Unit?

Kaiser, Jeffrey R.; Cassat, James E.; Lewno, Mary Jo

doi:10.1038/sj.jp.7210764

Cited by 33 publications

(25 citation statements)

References 6 publications

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“…When EOS is suspected at birth on the basis of symptoms or risk factors, empiric antibiotics are initiated before the causative agent is identified. These are usually continued for 48–72 h, at which time 97–98% of cultures ultimately yielding a pathogen are positive 3 4. Antibiotics may be continued longer if the infant was ever symptomatic as intrapartum antibiotics can result in falsely negative blood cultures.…”

Section: Introductionmentioning

confidence: 99%

Value of a single C-reactive protein measurement at 18 h of age

Lacaze‐Masmonteil

Rosychuk

Robinson

2013

Arch Dis Child Fetal Neonatal Ed

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Section: Introductionmentioning

confidence: 99%

Value of a single C-reactive protein measurement at 18 h of age

Lacaze‐Masmonteil

Rosychuk

Robinson

2013

Arch Dis Child Fetal Neonatal Ed

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“…We reported our findings in abstract form (4), showing a reduction in the use of vancomycin of 38% over the previous 12-month (6). At the same time, we also noted that infants improved on the new regimen, even those whose blood cultures subsequently grew CONS, most of which showed laboratory resistance to oxacillin.…”

Section: Resultsmentioning

confidence: 68%

“…Time to positivity of blood culture was not used as a criterion for contamination, although this has been proposed by others (6,13).…”

Section: Resultsmentioning

confidence: 99%

Coagulase-negative staphylococcal infections in a neonatal intensive care unit: In vivo response to cloxacillin

Blayney

Madani

2006

Paediatrics and Child Health

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BACKGROUND: Following the introduction of cloxacillin and gentamicin as the first line of treatment for possible late-onset sepsis (LOS) in the authors' neonatal intensive care unit (NICU), it was subsequently noted that very low birth weight (VLBW) infants improved clinically, despite subsequently positive blood cultures for oxacillinresistant, coagulase-negative Staphylococcus (CONS). The results of the management of VLBW infants with CONS sepsis during one calendar year, based on clinical rather than laboratory findings, are presented. METHODS: VLBW infants with LOS were identified through the neonatal database, and the charts of those with CONS were reviewed for antibiotic usage, antibiotic resistance pattern, clearance of CONS from the blood and NICU discharge status. Oxacillin sensitivity was determined by the presence of the mecA gene. RESULTS: From January 1 to December 31, 2002, 27 VLBW infants, treated in the authors' NICU for LOS due to CONS, were identified. The mean age of LOS infants with CONS was 15 days (median 12 days; range three to 54 days), the mean birth weight (± SD) was 904±247 g, and the mean gestational age at birth (± SD) was 27±2 weeks. All infants were started on cloxacillin and gentamicin, and improved clinically over the first 48 h. Six isolates were sensitive to cloxacillin. Twentythree infants grew oxacillin-resistant CONS, eight of whom had persistence of CONS on repeat culture secondary to central lines. Two infants grew two strains of CONS. Eighteen of 22 infants (82%) with in vitro oxacillin-resistant CONS had clearance of bacteremia with cloxacillin and gentamicin. Ten infants (37%) received vancomycin, based on the authors' guidelines. There were no cases of prolonged bacteremia requiring rifampicin. Three infants died, but none of the deaths could be attributed to CONS. DISCUSSION: The authors describe clinical improvement with clearance of CONS using cloxacillin and gentamicin, despite laboratory results suggesting oxacillin resistance. The authors' unit policy was based on clinical response and permitted the continuation of cloxacillin, provided that a repeat blood culture was negative. Vancomycin use was suggested for clinical deterioration or persistence of CONS. These results question the in vitro tests of resistance. Clearance of oxacillin-resistant CONS from the blood points to in vivo sensitivity, while the laboratory testing suggests in vitro resistance. The absence of subsequent positive blood cultures for CONS confirms clearance of this organism. CONCLUSION: It was demonstrated that cloxacillin (150 mg/kg/day dose), along with gentamicin, can clear CONS from the blood within 48 h. The relationship between in vivo and in vitro sensitivities also needs to be further studied both in the laboratory and in a prospective trial.

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“…Investigators have shown a 97% to 100% yield at 48 hours for positivity of blood cultures. [118][119][120][121][122][123][124][125] These data suggest that in the absence of clinical signs of sepsis, which suggest that the blood culture is falsely negative, antibiotics can be stopped after 48 hours of treatment, if the blood culture is negative.…”

Section: Duration Of Treatmentmentioning

confidence: 99%

Prevention and Treatment of Nosocomial Sepsis in the NICU

et al. 2004

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Nosocomial sepsis is a serious problem for neonates who are admitted for intensive care. It is associated with an increase in mortality, morbidity, and prolonged length of hospital stay. Thus, both the human and fiscal costs of these infections are high. Although the rate of nosocomial sepsis increases with the degree of both prematurity and low birth weight, no specific lab test has been shown to be very useful in improving our ability to predict who has a ''real'' blood-stream infection and, therefore, who needs to be treated with a full course of antibiotics. As a result, antibiotic use is double the rate of ''proven'' sepsis and we are facilitating the growth of resistant organisms in the neonatal intensive care unit. The purpose of this article is to describe simple changes in process, which when implemented, can reduce nosocomial infection rates in neonates and improve outcomes.

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Should Antibiotics be Discontinued at 48 Hours for Negative Late-Onset Sepsis Evaluations in the Neonatal Intensive Care Unit?

Abstract: Discontinuing antibiotic therapy for neonates with possible late-onset sepsis and negative cultures at 48 hours is appropriate and is now standard care in our NICU.

Cited by 33 publications

References 6 publications

Value of a single C-reactive protein measurement at 18 h of age

Value of a single C-reactive protein measurement at 18 h of age

Coagulase-negative staphylococcal infections in a neonatal intensive care unit: In vivo response to cloxacillin

Prevention and Treatment of Nosocomial Sepsis in the NICU

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