Use of polymerase chain reaction as a diagnostic tool for neonatal sepsis can result in a decrease in use of antibiotics and total neonatal intensive care unit length of stay

Abstract

Objective: To retrospectively determine if a negative 16S ribosomal RNA (rRNA) polymerase chain reaction (PCR) (PCR(À)) could lead to a decrease in the number of antibiotic doses and neonatal intensive care unit (NICU) length of stay (LOS) for infants admitted to the NICU for presumed early-onset sepsis (EOS) with negative blood culture results (BC(À)).Study design: Analysis included 419 infants, greater than 35 weeks gestational age, with PCR(À), BC(À) and LOS>48 h. Both the investigators and clinical care team were unaware of the PCR results. The actual number of antibiotic doses (AAD) administered was compared to an estimated number of antibiotics doses (EAD) that would have been given until PCR(À) results were available by 18 h. The number of antibiotic doses saved was calculated as (AADÀEAD). The actual NICU LOS in hours (aLOS) for a subset of infants who remained in the hospital primarily for antibiotic therapy was compared to an estimated LOS (eLOS) if infants with PCR(À) were discharged from the NICU when clinically stable. The number of hours saved was calculated as (aLOSÀeLOS).Results: Approximately eight antibiotic doses and 85 NICU hours per infant could be saved using PCR(À) results available at 18 h.Conclusions: Use of 16S rRNA PCR could decrease the number of antibiotics doses and NICU LOS for infants admitted for EOS. This may facilitate: (1) earlier NICU discharge; (2) parental satisfaction; and (3) decreased health care costs.

Methicillin-resistant Staphylococcus aureus nasal colonization in a level III neonatal intensive care unit: Incidence and risk factors

“…A correlation between colonization and sepsis by MRSA was not attempted because of the low yield of blood cultures in neonates. 27 Finally, because this was an observational study conducted in a single NICU in an university-affiliated hospital, the results may not be generalizable.…”

Enterococcus faecium AND Enterococcus faecalis IN BLOOD OF NEWBORNS WITH SUSPECTED NOSOCOMIAL INFECTION

“…Other studies have reported lower sensitivity of blood cultures 1,5,21 , despite being the gold standard for diagnosis of sepsis, is a time consuming technique, whose results are ready in no less time than 48 to 72 hours and several authors have questioned its credibility 5 .…”

Molecular Detection of Culture-Confirmed Bacterial Bloodstream Infections with Limited Enrichment Time

“…Ibrahim et al in a similar population determined that administration of inadequate or inappropriate antimicrobial treatment was also associated with increased hospital mortality (13). Rapid detection of BSI has the potential to not only improve patient outcomes due to quicker administration of appropriate antibiotics but also improve antibiotic stewardship by reducing patient exposures to ineffective or unnecessary broad-spectrum antibiotics (11,14). Additionally, the fact that 72.8% of all research samples from this study tested positive by the molecular approach after just 5 h of enrichment suggests that a large percentage may actually have been detected using this molecular approach even sooner.…”

“…Studies using real-time PCR to amplify universal sequences of the 16S rRNA gene were shown to have high sensitivity and specificity, as well as a very high negative predictive value (99.2%) when used in neonatal populations (7,10). The high negative predictive value of the PCR assay means that a negative result can be obtained within hours, not days, thus leading to a significant reduction in the duration of unnecessary antibiotic therapy (11).…”