Department of Internal Medicine, Ghent University, Ghent, Belgium.
Department of Neonatal Medicine, Antwerp University Hospital, Antwerp, Belgium.
Eur J Pediatr. 2018 Oct;177(10):1565-1572. doi: 10.1007/s00431-018-3203-1. Epub 2018 Jul 26.
Due to potential lethality of healthcare-associated sepsis (HAS), a low threshold for blood culturing and antimicrobial therapy (ABT) initiation is accepted. We assessed variability in the trigger for blood culturing between three neonatal intensive care units. A multicenter prospective cohort study was conducted. In newborns with suspicion of HAS, 10 predefined clinical signs, nosocomial sepsis (NOSEP) score, C-reactive protein, ABT initiation, and risk factors were registered at time of culturing. Outcome was lab-confirmed HAS, defined according to the NeoKISS-criteria. Two hundred ninety-nine suspected HAS episodes were considered in 212 infants, of which 118 had birth-weight ≤ 1500 g; proportion of lab-confirmed HAS per suspected episode was 30/192 (center 1), 28/60 (center 2), and 8/47 (center 3) (p < 0.001). Median C-reactive protein and number of clinical signs at time of culturing differed between centers 1, 2, and 3 (respectively 11 vs. 5 vs. 3 mg/L, p = 0.001; 1 sign [IQR 0-2, center 1] vs. 3 signs [IQR 2-4, centers 2 and 3], p < 0.001). Median NOSEP score at time of culturing was 5 (IQR 3-8, center 1), 5 (IQR 3-9, center 2), and 8 (IQR 5-11, center 3) (p = 0.016). Difference in ABT initiation was noticed (82 vs. 93 vs. 74%, p = 0.05).
Center heterogeneity in sampling practice is substantial. Optimizing sampling practice can be recommended. What is Known: • Blood culture test is a common diagnostic procedure in critically-ill newborns. • A low threshold for sampling and antimicrobial therapy initiation is accepted. What is New: • Variability in blood culture practice was assessed between 3 neonatal intensive care units by the registration of sampling frequencies, clinical indications, and antimicrobial therapy initiation.
由于与医疗保健相关的脓毒症（HAS）的潜在致命性，因此接受了较低的血液培养和抗生素治疗（ABT）启动阈值。我们评估了三个新生儿重症监护病房之间血液培养触发因素的差异。进行了一项多中心前瞻性队列研究。在疑似 HAS 的新生儿中，在培养时记录了 10 个预先定义的临床体征、医院获得性脓毒症（NOSEP）评分、C 反应蛋白、ABT 起始和危险因素。根据 NeoKISS 标准，将实验室确诊的 HAS 作为结局。在 212 名婴儿中考虑了 299 例疑似 HAS 发作，其中 118 例出生体重≤1500g；每个疑似病例的实验室确诊 HAS 比例为 30/192（中心 1）、28/60（中心 2）和 8/47（中心 3）（p<0.001）。中心 1、2 和 3 之间培养时的 C 反应蛋白和临床体征中位数不同（分别为 11 vs. 5 vs. 3mg/L，p=0.001；1 个体征[IQR 0-2，中心 1] vs. 3 个体征[IQR 2-4，中心 2 和 3]，p<0.001）。培养时的 NOSEP 评分中位数为 5（IQR 3-8，中心 1）、5（IQR 3-9，中心 2）和 8（IQR 5-11，中心 3）（p=0.016）。注意到 ABT 起始的差异（82% vs. 93% vs. 74%，p=0.05）。
采样实践中的中心异质性很大。可以推荐优化采样实践。
• 血液培养试验是危重新生儿的常见诊断程序。
• 接受了较低的采样和抗生素治疗启动阈值。
• 通过注册采样频率、临床指征和抗生素治疗起始，评估了 3 个新生儿重症监护病房之间的血液培养实践差异。
