Evelien Hilde Verstraete1, Ludo Mahieu2,3, James d'Haese4, Kris De Coen5, Jerina Boelens6, Dirk Vogelaers7,8, Stijn Blot7,9. 1. Department of Internal Medicine, Ghent University, Ghent, Belgium. ehverstr@gmail.com. 2. Department of Neonatal Medicine, Antwerp University Hospital, Antwerp, Belgium. 3. Department of Pediatrics, University of Antwerp, Antwerp, Belgium. 4. Department of Neonatal Medicine, General Hospital of Saint-Jan Bruges, Bruges, Belgium. 5. Department of Neonatal Medicine, Ghent University Hospital, Ghent, Belgium. 6. Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium. 7. Department of Internal Medicine, Ghent University, Ghent, Belgium. 8. Department of General Internal Medicine, Infectious Diseases and Psychosomatic Disorders, Ghent University Hospital, Ghent, Belgium. 9. Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.
Abstract
Due to potential lethality of healthcare-associated sepsis (HAS), a low threshold for blood culturing and antimicrobial therapy (ABT) initiation is accepted. We assessed variability in the trigger for blood culturing between three neonatal intensive care units. A multicenter prospective cohort study was conducted. In newborns with suspicion of HAS, 10 predefined clinical signs, nosocomial sepsis (NOSEP) score, C-reactive protein, ABT initiation, and risk factors were registered at time of culturing. Outcome was lab-confirmed HAS, defined according to the NeoKISS-criteria. Two hundred ninety-nine suspected HAS episodes were considered in 212 infants, of which 118 had birth-weight ≤ 1500 g; proportion of lab-confirmed HAS per suspected episode was 30/192 (center 1), 28/60 (center 2), and 8/47 (center 3) (p < 0.001). Median C-reactive protein and number of clinical signs at time of culturing differed between centers 1, 2, and 3 (respectively 11 vs. 5 vs. 3 mg/L, p = 0.001; 1 sign [IQR 0-2, center 1] vs. 3 signs [IQR 2-4, centers 2 and 3], p < 0.001). Median NOSEP score at time of culturing was 5 (IQR 3-8, center 1), 5 (IQR 3-9, center 2), and 8 (IQR 5-11, center 3) (p = 0.016). Difference in ABT initiation was noticed (82 vs. 93 vs. 74%, p = 0.05). CONCLUSION: Center heterogeneity in sampling practice is substantial. Optimizing sampling practice can be recommended. What is Known: • Blood culture test is a common diagnostic procedure in critically-ill newborns. • A low threshold for sampling and antimicrobial therapy initiation is accepted. What is New: • Variability in blood culture practice was assessed between 3 neonatal intensive care units by the registration of sampling frequencies, clinical indications, and antimicrobial therapy initiation.
Due to potential lethality of healthcare-associated sepsis (HAS), a low threshold for blood culturing and antimicrobial therapy (ABT) initiation is accepted. We assessed variability in the trigger for blood culturing between three neonatal intensive care units. A multicenter prospective cohort study was conducted. In newborns with suspicion of HAS, 10 predefined clinical signs, nosocomial sepsis (NOSEP) score, C-reactive protein, ABT initiation, and risk factors were registered at time of culturing. Outcome was lab-confirmed HAS, defined according to the NeoKISS-criteria. Two hundred ninety-nine suspected HAS episodes were considered in 212 infants, of which 118 had birth-weight ≤ 1500 g; proportion of lab-confirmed HAS per suspected episode was 30/192 (center 1), 28/60 (center 2), and 8/47 (center 3) (p < 0.001). Median C-reactive protein and number of clinical signs at time of culturing differed between centers 1, 2, and 3 (respectively 11 vs. 5 vs. 3 mg/L, p = 0.001; 1 sign [IQR 0-2, center 1] vs. 3 signs [IQR 2-4, centers 2 and 3], p < 0.001). Median NOSEP score at time of culturing was 5 (IQR 3-8, center 1), 5 (IQR 3-9, center 2), and 8 (IQR 5-11, center 3) (p = 0.016). Difference in ABT initiation was noticed (82 vs. 93 vs. 74%, p = 0.05). CONCLUSION: Center heterogeneity in sampling practice is substantial. Optimizing sampling practice can be recommended. What is Known: • Blood culture test is a common diagnostic procedure in critically-ill newborns. • A low threshold for sampling and antimicrobial therapy initiation is accepted. What is New: • Variability in blood culture practice was assessed between 3 neonatal intensive care units by the registration of sampling frequencies, clinical indications, and antimicrobial therapy initiation.
Authors: N Modi; C J Doré; A Saraswatula; M Richards; K B Bamford; R Coello; A Holmes Journal: Arch Dis Child Fetal Neonatal Ed Date: 2008-05-22 Impact factor: 5.747
Authors: Ludo M Mahieu; Jozef J De Dooy; Veerle R Cossey; Linde L Goossens; Sabine L Vrancken; Ann Y Jespers; Christina T Vandeputte; Aimé O De Muynck Journal: Crit Care Med Date: 2002-07 Impact factor: 7.598
Authors: Gary Laborada; Maria Rego; Ajey Jain; Michael Guliano; Joseph Stavola; Praveen Ballabh; Alfred N Krauss; Peter A M Auld; Mirjana Nesin Journal: Am J Perinatol Date: 2003-11 Impact factor: 1.862
Authors: Melissa L Arvay; Nong Shang; Shamim A Qazi; Gary L Darmstadt; Mohammad Shahidul Islam; Daniel E Roth; Anran Liu; Nicholas E Connor; Belal Hossain; Qazi Sadeq-Ur Rahman; Shams El Arifeen; Luke C Mullany; Anita K M Zaidi; Zulfiqar A Bhutta; Sajid B Soofi; Yasir Shafiq; Abdullah H Baqui; Dipak K Mitra; Pinaki Panigrahi; Kalpana Panigrahi; Anuradha Bose; Rita Isaac; Daniel Westreich; Steven R Meshnick; Samir K Saha; Stephanie J Schrag Journal: Lancet Glob Health Date: 2022-09 Impact factor: 38.927