Late-onset Sepsis in Extremely Premature Infants

Greenberg, Rachel G.; Kandefer, Sarah; Tiddi, Barbara; Smith, P. Brian; Stoll, Barbara J.; Bell, Edward F.; Carlo, Waldemar A.; Laptook, Abbot R.; Sánchez, Pablo J.; Shankaran, Seetha; Meurs, Krisa P. Van; Ball, Michelle; Hale, Ellen C.; Newman, Nancy S.; Das, Abhik; Higgins, Rosemary D.; Cotten, C. Michael

doi:10.1097/inf.0000000000001570

Cited by 161 publications

(123 citation statements)

References 28 publications

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“…The idea that clinicians should rely more on correctly drawn blood cultures to confirm infection, rather than decide to continue treatment according to the results of inflammatory markers, has also gained traction, with many advocating a reduction in the diagnosis of culture-negative sepsis. 18,104,105 In our opinion, there are many interesting strategies that require further investigation (see Table 2). With established evidence for the use of Pct-guided antibiotic stewardship, 45 this strategy should be considered to limit the ongoing treatment of culture-negative sepsis.…”

Section: Discussionmentioning

confidence: 99%

<p>Neonatal sepsis biomarkers: where are we now?</p>

Gilfillan¹,

Bhandari²

2019

RRN

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Given that neonatal sepsis remains an important factor contributing to mortality and morbidity in neonates, identification of accurate biomarkers to aid in its timely and accurate diagnosis is critical. In this review, we discuss the current evidence behind the use of biomarkers commonly used in clinical practice, as well as presenting recent developments in this area of research. Besides summarizing information regarding "traditional" biomarkers (eg, hematological indices, CRP, and other acute-phase reactants, cytokines), we provide the latest clinical status on some relatively "newer" biomarkers (eg, PCR-and "-omic" technology-based, biophysical biomarkers) in the diagnosis of neonatal sepsis. We believe that certain biophysical (RALIS, core-peripheral temperature differences) in combination with selective biochemical (procalcitonin, nCD64, presepsin) markers offer the best likelihood of being adopted for clinical use in the detection of neonatal sepsis in the near future. In addition, serial measurements of selective biochemical markers (procalcitonin, nCD64) offer promise in the decision to initiate and/or control the duration of antibiotic therapy. It is important to conduct adequately powered prospective multicenter studies to continue to establish the accuracy and safety of utilizing such biomarkers of neonatal sepsis so that appropriate and adequate therapy is tailored to each infant for optimal outcomes.

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Section: Discussionmentioning

confidence: 99%

<p>Neonatal sepsis biomarkers: where are we now?</p>

Gilfillan¹,

Bhandari²

2019

RRN

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“…Culture-confirmed EOS occurs in ~1% of VLBW infants, an incidence that is 20-fold higher than that in infants born with birth weight >2500 g 17. Culture-confirmed LOS is reported in ~20% of ELBW infants 18. Additionally, 5% of overall mortality in the ELBW population is attributable to infection and NEC 19.…”

Section: Risks and Benefits Of Antibiotics For Preterm Infantsmentioning

confidence: 99%

Challenges and opportunities for antibiotic stewardship among preterm infants

Mukhopadhyay

Sengupta²,

Puopolo³

2018

Arch Dis Child Fetal Neonatal Ed

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Antibiotic stewardship programmes aim to optimise antimicrobial use to prevent the emergence of resistance species and protect patients from the side effects of unnecessary medication. The high incidence of systemic infection and associated mortality from these infections leads neonatal providers to frequently initiate antibiotic therapy and make empiric antibiotic courses one of the main contributors of antibiotic use in the neonatal units. Yet, premature infants are also at risk for acute life-threatening complications associated with antibiotic use such as necrotising enterocolitis and for long-term morbidities such as asthma. In this review, we discuss specific aspects of antibiotic use in the very low birthweight preterm infants, with a focus on empiric use, that provide opportunities for stewardship practice. We discuss strategies to risk-stratify antibiotic initiation for the risk of early-onset sepsis, optimise empiric therapy duration and antibiotic choice in late-onset sepsis, and standardise decisions for stopping empiric therapy. Lastly, review the evolving role of biomarkers in antibiotic stewardship.

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“…In addition, screening of bodily fluids (e.g., blood and urine) may also require an invasive procedure, increasing the risk for LOS independently [6]. Several studies have identified risk factors for LOS, including a lower birth weight, gestational age (GA), and the presence of central venous catheters [1, 3, 7]. In addition, breastmilk feeding within the first month of life has been shown to be protective against LOS development [8].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Late-Onset Sepsis in Preterm Infants: A Multicenter Case-Control Study

et al. 2019

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Background: Late-onset sepsis (LOS) in preterm infants is a leading cause of mortality and morbidity. Timely recognition and initiation of antibiotics are important factors for improved outcomes. Identification of risk factors could allow selection of infants at an increased risk for LOS. Objectives: The aim was to identify risk factors for LOS. Methods: In this multicenter case-control study, preterm infants born at ≤30 weeks of gestation were included at 9 neonatal intensive care units. Detailed demographical and clinical data were collected daily up to day 28 postnatally. Clinical and demographic risk factors were identified using univariate and multivariate regression analyses in a 1: 1 matched case-control cohort. Results: In total, 755 infants were included, including 194 LOS cases (41 gram-negative cases, 152 gram-positive cases, and 1 fungus). In the case-control cohort, every additional day of parenteral feeding increased the risk for LOS (adjusted OR = 1.29; 95% CI 1.07–1.55; p = 0.006), whereas antibiotics administration decreased this risk (OR = 0.08; 95% CI 0.01–0.88; p = 0.039). These findings could largely be attributed to specific LOS-causative pathogens, since these predictive factors could be identified for gram-positive, but not for gram-negative, LOS cases. Specifically cephalosporins administration prior to clinical onset was inversely related to coagulase-negative staphylococcus LOS (CoNS-LOS) development. Formula feeding was an independent risk factor for development of CoNS-LOS (OR = 3.779; 95% CI 1.257–11.363; p = 0.018). Conclusion: The length of parenteral feeding was associated with LOS, whereas breastmilk administration was protective against CoNS-LOS. A rapid advancement of enteral feeding, preferably with breastmilk, may proportionally reduce the number of parenteral feeding days and consequently the risk for LOS.

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Late-onset Sepsis in Extremely Premature Infants

Cited by 161 publications

References 28 publications

<p>Neonatal sepsis biomarkers: where are we now?</p>

<p>Neonatal sepsis biomarkers: where are we now?</p>

Challenges and opportunities for antibiotic stewardship among preterm infants

Risk Factors for Late-Onset Sepsis in Preterm Infants: A Multicenter Case-Control Study

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