The influence of intrapartum antibiotic therapy on the diagnosis of early-onset neonatal sepsis

Abstract

ResumoObjetivo: Determinar a repercussão do uso de antibióticos pelas mães no resultado das hemoculturas e culturas de secreções dos recém-nascidos com suspeita clínica de infecção precoce.Material e Métodos: No período de agosto de 1995 a julho de 1996, foram analisados 69 casos seqüenciais de recém-nascidos com sepse ou síndrome séptica precoce. Os recém-nascidos foram acompanhados para seus desfechos clínicos: crescimento ou não de germe em suas culturas de secreções (sangue, urina, líquor, secreção traqueal ou cateter umbilical). O tamanho mínimo de amostra calculado foi 17 para cada grupo, considerando um nível de significância de 5%.Resultados: Em 17 foi constatado uso de antibiótico previamente ao parto, sendo ampicilina isoladamente ou em associação com gentamicina a opção em 70% das mães. Infecção urinária materna ocorreu em 9 casos (53%), amnionite em 6 casos, em 1 caso observou-se associação de ambos e noutro caso a mãe tinha erisipela. No grupo de mães que não receberam antibiótico (n=52), houve 13 recém-nascidos com culturas positivas; nas 17 mães em tratamento antimicrobiano, nenhum recém-nascido teve culturas positivas (p=0,0164) . O risco relativo de ter cultura positiva se a mãe não tomar antibiótico é 12 vezes maior do que se a mãe tiver recebido antibiótico.Conclusão: O uso de antibióticos antes do parto de recém-nascidos com sepse ou síndrome séptica pode fazer com que as hemoculturas resultem negativas, aumentando a dificuldade diagnóstica da sepse neonatal precoce.J. pediatr. (Rio J.). 1997; 73(3):171-175: infecção neonatal, antibioticoterapia, hemocultura, síndrome séptica, sepse. AbstractObjective: To determine the influence of intrapartum antibiotic therapy on blood and secretion cultures of newborn infants suspected of early-onset sepsis.Material and Methods: From August 1995 through July 1996, 69 sequential newborn infants with early-onset sepsis or septic syndrome were included in the study. All of them were followed for the end point: positivity of blood, urine, CSF, tracheal secretion or umbilical catheter cultures. The sample size was figured out to be 17 for each group, for a significant level of 5%.Results: Seventeen mothers were treated with antibiotic. Ampicillin alone or in association with other drugs was utilized in 70% of them. Urinary tract infection occurred in 9 mothers (53%), ammonites in 6, one mother had both and another one had erysipelas. Thirteen newborn infants had positive cultures in the group whose the mothers had not received antibiotic (n=52), none of the 17 newborn infants delivered by the mothers treated with antibiotic had any positive culture (p=0.0164). The relative risk of positive culture in a septic neonate if the mother is not treated with antibiotic is 12 times higher than if the mother is treated with antibiotic.Conclusion: The use of intrapartum antibiotic in newborn infants with early-onset sepsis or septic syndrome may cause a negativity of cultural exams, increasing the difficulty of the diagnosis of early-onset neonatal sepsis.J. pediatr. (Ri...

Prospective evaluation of the usefulness of C-reactive protein in the diagnosis of neonatal sepsis in a sub-Saharan African region

“…This is much too high to base the decision not to start empirical antibiotics for a neonate with suspected sepsis. Particularly as CRP was only tested to predict positive blood culture which may represent only a proportion of neonates with sepsis [ 24 ], especially if the patient had been on antibiotic therapy before presentation as is common in Sub-Saharan Africa. A negative CRP, however can be useful in aiding the decision to discontinue antibiotics especially if the neonate has no clinical feature of sepsis.…”

Neonatal Sepsis;

“…This value is higher for making a decision not to start empirical antibiotic therapy for a suspected septic neonate, particularly when CRP is estimated keeping blood culture gold standard, and its positivity may represent only a proportion these subjects. 19 Particularly, if a neonate is given antibiotics before presenting to the clinician as is common in our setup or if mother is given antibiotics intra-partum. A negative CRP test in neonates without clinical feature is helpful in making decision to discontinue antibiotics, thus facilitating early discharge with significant reduction in complications and cost of treatment.…”

Leukositosis pada Ibu Sebagai Salah Satu Faktor Risiko Infeksi Neonatal Awitan Dini: Telaah Klinis di RSAB Harapan Kita

“…Keadaan ini berhubungan dengan pemberian profilaksis antibiotik pada ibu untuk mencegah kolonisasi kuman, tetapi tidak cukup kuat mencegah timbulnya INAD. 26 Hasil biakan dapat positif palsu karena terdapat kontaminasi. 27 Pendapat lain menyatakan bahwa infeksi adalah suatu sindrom klinis akibat proses bakteremi yang melibatkan berbagai organ dan bukan diagnosis akhir, oleh sebab itu sulit menentukan baku emas diagnosis infeksi atau sepsis.…”