Armstrong Sean J, Brady Jennifer J, Drew Richard J, Foran Adrienne
Rotunda Hospital, Dublin, Ireland.
Department of Clinical Biochemistry, Children's Health Ireland, Dublin, Ireland.
Pediatr Res. 2024 Oct 25. doi: 10.1038/s41390-024-03670-x.
Procalcitonin-guided antimicrobial decision-making has been shown to be safe in adult intensive care settings. Most antimicrobial exposure in neonatal units is in culture-negative conditions. We hypothesise that Procalcitonin aids antimicrobial stewardship efforts in suspected Late-Onset Neonatal Sepsis.
Neonates were enrolled if they were aged over 72 h and were placed on antibiotics for a suspected infection. Procalcitonin levels were taken at set timepoints for the duration of antimicrobial exposure. Three subgroups were created: non-infectious episodes, blood culture-negative infectious episodes, and bloodstream infections.
Eighty-five suspected infectious episodes were recruited across two tertiary neonatal and paediatric intensive care units. There was a significant difference between the median PCT in bloodstream infections (BSI) compared to non-infectious episodes (2.13 versus 0.26 µg/L, p < 0.001). A cut-off of 0.5 µg/L had sensitivity 92.9% and specificity 68% for bloodstream infections at 24 h. The difference between median PCT values at 24 h was significant (0.27 vs 7.08; p < 0.001) for feed intolerance vs. NEC Grade IIIa-IIIb subgroups.
Procalcitonin levels taken 24 h following evaluation for late-onset neonatal infection are useful in out ruling BSI or severe Necrotising Enterocolitis. Up to 30% of antimicrobial exposure could be avoided with the use of Procalcitonin levels in low-risk neonates.
This study demonstrates the utility of serial Procalcitonin measurements in antimicrobial stewardship efforts in the Neonatal Unit. Procalcitonin can be used to aid in antimicrobial decision making in suspected Late-Onset neonatal infection. Procalcitonin testing at twenty-four hours in episodes of Gastrointestinal deterioration can out rule Bells Grade III Necrotising Enterocolitis.
降钙素原指导下的抗菌决策在成人重症监护环境中已被证明是安全的。新生儿病房中的大多数抗菌药物暴露是在培养结果为阴性的情况下进行的。我们假设降钙素原有助于疑似晚发性新生儿败血症的抗菌管理工作。
纳入年龄超过72小时且因疑似感染而使用抗生素的新生儿。在抗菌药物暴露期间的设定时间点采集降钙素原水平。创建了三个亚组：非感染性发作、血培养阴性的感染性发作和血流感染。
在两个三级新生儿和儿科重症监护病房共招募了85例疑似感染性发作。与非感染性发作相比，血流感染（BSI）的降钙素原中位数存在显著差异（2.13对0.26µg/L，p<0.001）。对于24小时时的血流感染，0.5µg/L的临界值敏感性为92.9%，特异性为68%。喂养不耐受与坏死性小肠结肠炎IIIa-IIIb亚组在24小时时降钙素原中位数的差异显著（0.27对7.08；p<0.001）。
对晚发性新生儿感染进行评估后24小时测定的降钙素原水平有助于排除血流感染或严重坏死性小肠结肠炎。在低风险新生儿中使用降钙素原水平可避免高达30%的抗菌药物暴露。
本研究证明了连续测定降钙素原在新生儿病房抗菌管理工作中的实用性。降钙素原可用于辅助疑似晚发性新生儿感染的抗菌决策。在胃肠道恶化发作24小时时进行降钙素原检测可排除贝尔III级坏死性小肠结肠炎。
