Management of early‐onset neonatal sepsis differs in the north and south of Scandinavia

Drageset, Martin; Fjalstad, Jon Widding; Mortensen, Sven; Klingenberg, Claus

doi:10.1111/apa.13698

Cited by 18 publications

(16 citation statements)

References 27 publications

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“…A number of different studies published since 2012 report that infants receiving systemic antibiotic therapy for culture-negative sepsis outnumber infants receiving therapy for culture-confirmed sepsis by a factor of six to 16 (Table 1 ). The reason for the high number of culture-negative cases is not clear, and diagnostic criteria used in the different publications vary substantially ( 10 , 11 , 23 , 24 , 26 , 27 ). Low levels of bacteremia or only small volumes of blood obtained from sick infants may be one explanation for the high number of culture-negative sepsis cases.…”

Section: Efficient Sepsis Care—basic Elementsmentioning

confidence: 99%

“…The UK NICE-guidelines states that the usual duration of antibiotic treatment for babies with a positive blood culture, and for those with a negative blood culture but in whom there has been strong suspicion of sepsis, should be 7 days ( 8 ). In observational studies, infants with culture-negative sepsis are commonly treated for 5–7 days and mortality is very low ( 10 , 11 , 23 ). However, due to variable sepsis definitions it is not possible to assess “safety” vs. a clear possibility of harm due to overtreatment ( 69 ).…”

Section: Antimicrobial Stewardship In the Neonatal Unitmentioning

confidence: 99%

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Culture-Negative Early-Onset Neonatal Sepsis — At the Crossroad Between Efficient Sepsis Care and Antimicrobial Stewardship

et al. 2018

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Sepsis is a leading cause of mortality and morbidity in neonates. Presenting clinical symptoms are unspecific. Sensitivity and positive predictive value of biomarkers at onset of symptoms are suboptimal. Clinical suspicion therefore frequently leads to empirical antibiotic therapy in uninfected infants. The incidence of culture confirmed early-onset sepsis is rather low, around 0.4–0.8/1000 term infants in high-income countries. Six to 16 times more infants receive therapy for culture-negative sepsis in the absence of a positive blood culture. Thus, culture-negative sepsis contributes to high antibiotic consumption in neonatal units. Antibiotics may be life-saving for the few infants who are truly infected. However, overuse of broad-spectrum antibiotics increases colonization with antibiotic resistant bacteria. Antibiotic therapy also induces perturbations of the non-resilient early life microbiota with potentially long lasting negative impact on the individual‘s own health. Currently there is no uniform consensus definition for neonatal sepsis. This leads to variations in management. Two factors may reduce the number of culture-negative sepsis cases. First, obtaining adequate blood cultures (0.5–1 mL) at symptom onset is mandatory. Unless there is a strong clinical or biochemical indication to prolong antibiotics physician need to trust the culture results and to stop antibiotics for suspected sepsis within 36–48 h. Secondly, an international robust and pragmatic neonatal sepsis definition is urgently needed. Neonatal sepsis is a dynamic condition. Rigorous evaluation of clinical symptoms (“organ dysfunction”) over 36–48 h in combination with appropriately selected biomarkers (“dysregulated host response”) may be used to support or refute a sepsis diagnosis.

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Section: Efficient Sepsis Care—basic Elementsmentioning

confidence: 99%

Section: Antimicrobial Stewardship In the Neonatal Unitmentioning

confidence: 99%

Culture-Negative Early-Onset Neonatal Sepsis — At the Crossroad Between Efficient Sepsis Care and Antimicrobial Stewardship

et al. 2018

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“…Outpatient antibiotic use in Norwegian children has decreased significantly during the recent years [6]. Studies in Scandinavian inpatient term born infants indicate that antibiotic use can be reduced and that empirical treatment for sepsis varies [7,8]. Furthermore, Raastad et al revealed a significantly increased consumption of BSA in a highly specialized Norwegian pediatric department [9].…”

Section: Introductionmentioning

confidence: 99%

Potential for More Rational Use of Antibiotics in Hospitalized Children in a Country With Low Resistance

Thaulow

Berild

Eriksen

et al. 2019

Pediatric Infectious Disease Journal

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“…In choice of antibiotics, adherence to local hospital guidelines was high and the use of BSA was low. Previous studies show that several Norwegian hospitals use benzylpenicillin instead of ampicillin in empirical treatments combined with an aminoglycoside (11,16,40), and this variation is also present world-wide (41). High prevalence of Listeria monocytogenes could justify the use of ampicillin, but according to data from The Norwegian Institute of Public Health, only four cases of listeriosis have been reported among Norwegian children (< 1 year) from 2011 to 2018 (42).…”

Section: Discussionmentioning

confidence: 99%

Can we optimize antibiotic use in Norwegian neonates? A prospective comparison between a university hospital and a district hospital

Thaulow

Berild

Blix

et al. 2019

Infection, Disease & Health

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Background: Worldwide, a large proportion of neonates are prescribed antibiotics without having infections leading to increased antimicrobial resistance, disturbance of the evolving microbiota, and increasing the risk of various chronical diseases. Comparing practice between different hospitals/settings is important in order to optimize antibiotic stewardship.Aim: To investigate and compare the potential for improved antibiotic stewardship in neonates in two Norwegian hospitals with different academic culture, with emphasis on antibiotic exposure in unconfirmed infections, treatment length/doses, CRP values and the use of broad-spectrum antibiotics (BSA). All types of infections were investigated, but the main focus was on early-onset sepsis (EOS). Methods:We conducted a prospective observational cohort study of antibiotic use in a Norwegian university hospital (UH) and a district hospital (DH), 2017. Unconfirmed infections were defined as culture negative infections that neither fulfilled the criteria for clinical infection (clinical symptoms, maximum CRP >30 mg/L, and treatment for at least 5 days).Results: Ninety-five neonates at the DH and 89 neonates at the UH treated with systemic antibiotics were included in the study. In total, 685 prescriptions (daily doses) of antibiotics were given at the DH and 903 at the UH. Among term and premature infants (≥ 28 weeks), 82% (75% at the UH and 86% at the DH, p = 0.172) of the treatments for suspected EOS were for unconfirmed infections, and average treatment length in unconfirmed infections was 3.1 days (both hospitals). Median dose for aminoglycoside was higher for term infants at the UH (5.96, 95% CI 5.02-6.89) compared to the DH (4.98, 95% CI 4.82-5.14; p < 0.001). At the UH, all prescriptions with aminoglycosides were gentamicin, while tobramycin accounted for 93% of all prescriptions with aminoglycosides at the DH. Thaulow et al. Antibiotic Use in Norwegian NeonatesConclusion: There is a potential for reduction in both antibiotic exposure and treatment length in these two neonatal units, and a systematic risk/observational algorithm of sepsis should be considered in both hospitals. We revealed no major differences between the UH and DH, but doses and choice of aminoglycosides varied significantly.

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Management of early‐onset neonatal sepsis differs in the north and south of Scandinavia

Abstract: There were marginal differences in the management of EONS between units in Denmark and Norway, mainly in their choice of antibiotics and the use of lumbar punctures. Staphylococcus aureus was the most common pathogen.

Cited by 18 publications

References 27 publications

Culture-Negative Early-Onset Neonatal Sepsis — At the Crossroad Between Efficient Sepsis Care and Antimicrobial Stewardship

Culture-Negative Early-Onset Neonatal Sepsis — At the Crossroad Between Efficient Sepsis Care and Antimicrobial Stewardship

Potential for More Rational Use of Antibiotics in Hospitalized Children in a Country With Low Resistance

Can we optimize antibiotic use in Norwegian neonates? A prospective comparison between a university hospital and a district hospital

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