Vogeti R, Choudhary S K, Singh A K, Gupta N, Tak V, Sunda U
Department of Neonatology, AIIMS, Jodhpur, India.
Department of Microbiology, AIIMS, Jodhpur, India.
J Neonatal Perinatal Med. 2025 Mar;18(2):157-164. doi: 10.1177/19345798251318588. Epub 2025 Mar 4.
BackgroundAntibiotic usage is rampant in NICUs. The time of stoppage of antibiotics depends predominantly on clinical condition of the neonate and final blood culture report. Delay in availability of report due to lab logistics might delay the stoppage of antibiotic. Hence, we hypothesized that having a point of care BACTEC system in NICU premises might reduce the delay, allowing earlier stoppage of antibiotics when no more warranted.ObjectiveTo compare the antibiotic usage (number of antibiotic doses) in neonates warranting antibiotics for suspected sepsis (both early onset and late onset sepsis) when the point of care blood culture system (BACTEC) has been used as compared to the central lab system.Design, Setting, and ParticipantsThis open labelled randomized controlled trial was conducted in a tertiary care NICU from November 2021 to April 2023. Inborn neonates with suspected sepsis in whom antibiotics were considered first time were participants.InterventionsFirst blood cultures in neonates with suspected sepsis were placed in NICU BACTEC or sent to the central lab as per randomization.Main Outcome MeasuresBoth the groups were compared for number of antibiotic doses.Results268 eligible neonates were randomized, 132 in point of care and 136 in central lab arm. Median antibiotic doses in neonates with suspected sepsis were 13 (7,25) versus 12 (8,29) in NICU versus central lab BACTEC arm ( = 0.501). Antibiotics were stopped in ≤48 hours in 25% neonates and 19.9% in NICU and central lab BACTEC, respectively. The mean antibiotic doses of the neonates whose antibiotics were stopped before 48 hours is 5.6 +/- 0.9 versus 6.3 +/- 1.5 in NICU versus central lab BACTEC arm ( = 0.042). There was no significant difference in mortality, necrotizing enterocolitis (NEC), subsequent culture-positive sepsis, fungal sepsis, and duration of hospital stay in both groups. In the central lab group, the mean time taken for the final report to be uploaded was 131 +/- 43 hours.ConclusionsThere was no significant difference in number of antibiotic doses among NICU and central lab arms. However, antibiotics were stopped early (<48 hours) in more neonates when point of care BACTEC was used. Establishing the effect of point of care blood culture system in reducing antibiotic use requires further studies with a larger sample size.
背景
新生儿重症监护病房（NICUs）中抗生素的使用非常普遍。抗生素停用时间主要取决于新生儿的临床状况和最终的血培养报告。由于实验室后勤问题导致报告延迟可能会延迟抗生素的停用。因此，我们推测在新生儿重症监护病房配备即时检测BACTEC系统可能会减少延迟，在不再需要时能更早停用抗生素。
目的
比较在使用即时检测血培养系统（BACTEC）与中央实验室系统时，因疑似败血症（早发型和晚发型败血症）而需要使用抗生素的新生儿的抗生素使用情况（抗生素剂量数量）。
设计、地点和参与者
这项开放标签随机对照试验于2021年11月至2023年4月在一家三级护理新生儿重症监护病房进行。首次被考虑使用抗生素的疑似败血症的足月儿为参与者。
干预措施
疑似败血症新生儿的首次血培养根据随机分组被放置在新生儿重症监护病房的BACTEC中或送往中央实验室。
主要观察指标
比较两组的抗生素剂量数量。
结果
268名符合条件的新生儿被随机分组，132名在即时检测组，136名在中央实验室组。疑似败血症新生儿的抗生素剂量中位数在新生儿重症监护病房组为13（7，25），而在中央实验室BACTEC组为12（8，29）（P = 0.501）。分别有25%和19.9%的新生儿在≤48小时内停用抗生素，在新生儿重症监护病房组和中央实验室BACTEC组。在48小时前停用抗生素的新生儿的平均抗生素剂量在新生儿重症监护病房组为5.6 +/- 0.9，而在中央实验室BACTEC组为6.3 +/- 1.5（P = 0.042）。两组在死亡率、坏死性小肠结肠炎（NEC）、随后的培养阳性败血症、真菌败血症和住院时间方面没有显著差异。在中央实验室组，最终报告上传的平均时间为131 +/- 43小时。
结论
新生儿重症监护病房组和中央实验室组在抗生素剂量数量上没有显著差异。然而，使用即时检测BACTEC时，更多新生儿在早期（<48小时）停用了抗生素。确定即时检测血培养系统在减少抗生素使用方面的效果需要进一步进行更大样本量的研究。
