1165 Rectal Swabs: an Increasingly Important Component of Nicu Infection Surveillance Programmes?

Abstract

Abstractsinflammatory response syndrome (SIRS) and sepsis adoptable for paediatric patients. We aimed to examine the applicability of the pediatric definitions of SIRS and sepsis to newborns in the diagnosis of early (EOS) and late onset sepsis (LOS). Methods Retrospective cohort study including 1. all term newborns hospitalized within the first 24 hours of life and 2. all infants with episodes of suspected LOS with a corrected gestational age of >37 weeks at onset of LOS from 2004 to 2008.Results Thirteen of 245 newborns included had culture proven EOS (5%) and 5 newborns had culture proven LOS. SIRS and sepsis criteria applied to 38% of EOS positive infants and to 100% of LOS positive infants. The two major diagnostic criteria white blood cell count and fever/hypothermia, of which at least one has to apply for fulfilling SIRS and sepsis criteria, had a sensitivity of 15% and 38% in diagnosis of EOS and of 100% and 80% in diagnosis of LOS, respectively. Conclusions The definitions of SIRS and sepsis applied to all cases of culture proven LOS. However, the single diagnostic criteria were insensitive in diagnosis of culture proven EOS with thus wrong classification of more than 60% of all cases. An evidence based approach to find the appropriate criteria for defining EOS in newborns is needed. DOES MATERNAL INTRAPARTUM ANTIBIOTICS PROLONG THE INCUBATION TIME REQUIRED FOR BLOOD CULTURES TO BECOME POSITIVE FOR INFANTS WITH EARLY-ONSET SEPSIS?doi We hypothesize that maternal intrapartum antibiotic treatment delays the growth of organism in the blood culture obtained during the workup for infants with suspected early-onset sepsis (EOS). The aim is to determine if maternal intrapartum antibiotic treatment prolongs the time to blood culture positivity in infants with EOS. Methods Single center, retrospective review of infants with blood culture-proven EOS over a 12 years period. EOS was defined by isolation of a pathogen from blood culture drawn within 72 hours of birth and antibiotic treatment for ≥5 days. The automated bacteremia detection was with BacTAlert Peds bottles. Results Among 88 infants with positive blood culture; 38 were deemed to have EOS, and 50 were deemed contaminants. Seventeen with EOS did not receive intrapartum antibiotics and had blood cultures drawn for being symptomatic after birth. The other 21 infants received intrapartum antibiotics and had EOS workup primarily for maternal chorioamnionitis. The median (IQR) time to blood culture positivity in all 38 infants with EOS was 19.7 h (16.5 h, 22.5 h), and the organisms grown were: Escherichia Coli in 17, Group B Streptococcus in 10, Alpha hemolytic Streptococci in 6, and other organisms in 5. The median (IQR) incubation time to blood culture positivity was not different in infants who received intrapartum antibiotics compared to infants who did not (19.6 h, IQR 16 h-28 h, versus 19.5 h, IQR 17.2 h-21.6 h, p=0.7489). Conclusion Maternal intrapartum antiobiotic treatment did not delay the time to blood culture positivity in infants with EOS.