Predicting late-onset sepsis by routine neonatal screening for colonisation by gram-negative bacteria in neonates at intensive care units: a protocol for a systematic review

Abstract

IntroductionHospitals conduct extensive screening procedures to assess colonisation of the body surface of neonates by gram-negative bacteria to avoid complications like late-onset sepsis. However, the benefits of these procedures are controversially discussed. Until now, no systematic review has investigated the value of routine screening for colonisation by gram-negative bacteria in neonates for late-onset sepsis prediction.Methods and analysisWe will conduct a systematic review, considering studies of any design that include infants up to an age of 12 months. We will search MEDLINE and EMBASE (inception to 2016), reference lists and grey literature. Screening of titles, abstracts and full texts will be conducted by two independent reviewers. We will extract data on study characteristics and study results. Risk of bias will be assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and Quality in Prognosis Studies (QUIPS) tools. Subgroup analyses are planned according to characteristics of studies, participants, index tests and outcome. For quantitative data synthesis on prognostic accuracy, sensitivity and specificity of screening to detect late-onset sepsis will be calculated. If sufficient data are available, we will calculate summary estimates using hierarchical summary receiver operating characteristics and bivariate models. Applying a risk factor approach, pooled summary estimates will be calculated as relative risk or OR, using fixed-effects and random-effects models. I-squared will be used to assess heterogeneity. All calculations will be performed in Stata V14.1 (College Station, Texas, USA). The results will be used to calculate positive and negative predictive value and number needed to be screened to prevent one case of sepsis. Grading of Recommendations Assessment, Development and Evaluation (GRADE) will be used to assess certainty in the evidence. The protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guideline.Ethics and disseminationThis study will not require ethical approval since it is not carried out in humans. The systematic review will be published in an open-access peer-reviewed journal.Trial registration numberCRD42016036664.

Bacterial colonisation of the endotracheal tube in ventilated very preterm neonates: A retrospective cohort study

“…Septicaemia is a major complication in the preterm neonate 2 . We showed a significant association between the presence of ETT bacterial colonisation and rates of septicaemia.…”

“…22 Septicaemia is a major complication in the preterm neonate. 2 We showed a significant association between the presence of ETT bacterial colonisation and rates of septicaemia. Harris et al also reported that septicaemia was significantly more likely in neonates with colonised tracheas.…”

“…Very preterm infants often require respiratory support with mechanical ventilation via an endotracheal tube (ETT). They are also at risk of significant morbidity, especially neonatal chronic lung disease (CLD) and septicaemia, 1,2 which prolong admissions and increase the risk of death. 1,3 Bacterial colonisation of a ventilated neonate's ETT is common.…”

Multi-drug resistance and high mortality associated with community-acquired bloodstream infections in children in conflict-affected northwest Nigeria

“…Pediatric sepsis accounts for approximately 8% of all critically ill children 27 . In 2020 WHO called for global action on sepsis with a focus on improving data from low-income countries with better definitions for sepsis and more information on microbiological aspects and antibiotic resistance 28,29 .…”

Screening for colonisation with gentamicin-resistant Gram-negative organisms on the neonatal unit: does positive screening predict sepsis?

“…During our study, we had two separate periods where screening was useful in identifying spread of colonisation without the development of bloodstream infection with resistant Enterobacter between patients leading to enhanced infection control practices and changes to equipment cleaning regimens. Future studies should assess more effective strategies for targeted surveillance for GNB in the neonatal population 4. It is important to recognise that screening has other important roles in understanding and managing the emergence of resistant-strain colonisation or to appropriately modify local antibiotic protocols for LOS.…”