van der Weijden Bo M, van Dorth Jolien R, Achten Niek B, Plötz Frans B
Department of Paediatrics, Tergooi MC, Laan van Tergooi 2, 1212 VG Hilversum, The Netherlands.
Department of Paediatrics, Amsterdam UMC, Emma Children's Hospital, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Antibiotics (Basel). 2024 Apr 25;13(5):388. doi: 10.3390/antibiotics13050388.
Early-onset sepsis (EOS) is a rare but profoundly serious bacterial infection. Neonates at risk of EOS are often treated with antibiotics. The start of empiric antibiotic therapy can successfully be reduced by the implementation of the EOS calculator. However, once started, antibiotic therapy is often continued despite a negative blood culture. To decrease the burden of antibiotic therapy, it is necessary to know whether the clinician's reasons are based on objective factors. Therefore, we performed a retrospective single-centre cohort study to identify the factors associated with prolongation of antibiotic therapy in neonates with suspected EOS but a negative blood culture. Maternal, clinical, and laboratory data of neonates with a gestational age of ≥32 weeks, admitted between January 2019 and June 2021, were collected. Among neonates with a negative blood culture, we compared neonates with prolonged (≥3 days) to neonates with discontinued (<3 days) antibiotic therapy. The clinician's reported reasons for prolonging therapy were explored. Blood cultures were positive in 4/146 (2.7%), negative in 131/146 (89.7%), and not obtained in 11/146 (7.5%) of the neonates. The incidence of EOS was 0.7 per 1000 neonates. Of the 131 neonates with a negative blood culture, 47 neonates (35.9%) received prolonged antibiotic therapy. In the prolonged group, the mean gestational age was higher (38.9 versus 36.8 weeks), and spontaneous preterm birth was less prevalent (21.3% versus 53.6%). Prolonged treatment was associated with late onset of respiratory distress, respiratory rate, hypoxia, apnoea and bradycardia, pale appearance, behavioural change, and elevated CRP levels. The most reported reasons were clinical appearance (38.3%), elevated CRP levels (36.2%), and skin colour (10.6%). Prolonging empiric antibiotic therapy despite a negative blood culture is common in suspected EOS. Clinical signs associated with prolongation are uncommon and the reported reasons for prolongation contain subjective assessments and arbitrary interpretations that are not supported by the guideline recommendations as arguments for prolonged therapy.
早发型败血症（EOS）是一种罕见但极其严重的细菌感染。有EOS风险的新生儿通常会接受抗生素治疗。通过使用EOS计算器，可以成功减少经验性抗生素治疗的起始时间。然而，一旦开始治疗，即使血培养结果为阴性，抗生素治疗通常仍会继续。为了减轻抗生素治疗的负担，有必要了解临床医生的理由是否基于客观因素。因此，我们进行了一项回顾性单中心队列研究，以确定与疑似EOS但血培养阴性的新生儿抗生素治疗延长相关的因素。收集了2019年1月至2021年6月期间入院的胎龄≥32周的新生儿的母亲、临床和实验室数据。在血培养阴性的新生儿中，我们将抗生素治疗延长（≥3天）的新生儿与抗生素治疗中断（<3天）的新生儿进行了比较。探讨了临床医生报告的延长治疗的原因。146例新生儿中，4例（2.7%）血培养阳性，131例（89.7%）血培养阴性，11例（7.5%）未进行血培养。EOS的发病率为每1000例新生儿0.7例。在131例血培养阴性的新生儿中，47例（35.9%）接受了延长的抗生素治疗。在延长治疗组中，平均胎龄较高（38.9周对36.8周），自然早产的发生率较低（21.3%对53.6%）。延长治疗与呼吸窘迫、呼吸频率、缺氧、呼吸暂停和心动过缓的迟发、面色苍白、行为改变以及CRP水平升高有关。报告最多的原因是临床表现（38.3%）、CRP水平升高（36.2%）和肤色（10.6%）。在疑似EOS的情况下，尽管血培养阴性仍延长经验性抗生素治疗的情况很常见。与延长治疗相关的临床体征并不常见，报告的延长治疗原因包含主观评估和任意解释，这些都没有得到指南建议的支持，不能作为延长治疗的依据。
