135 Time to positivity of neonatal blood cultures: Is it time to question the 48-hour empiric antibiotic rule?
Notice bibliographique
Résumé
Empiric antibiotic therapy for suspected sepsis is a common practice in neonatal intensive care units (NICU). While standard practice is to discontinue antibiotic therapy when blood cultures remain negative after 48 hours, it remains unclear whether this is the true time range to positivity of blood cultures in the neonatal population across all gestational ages. Gaining an empirical understanding of the time required to detect organisms implicated in neonatal sepsis may allow for a reduction of antibiotic exposure in non-septic neonates. The objectives of this study were to determine (1) the time required for neonatal blood cultures for suspected sepsis to become positive; (2) the proportion of cultures that become positive 24 hours or greater after collection; (3) differences between time to positivity for early versus late onset sepsis and; (4) perinatal and neonatal factors related to time to positivity of blood culture. This was a retrospective observational study of blood cultures drawn in neonates within the first 30 days of life with initiation of empiric antibiotic therapy between January 1, 2013 to December 31, 2017 at a level III Canadian NICU. Blood cultures drawn after initiation of antibiotic therapy were excluded. Data was analyzed using descriptive statistics, chi-square and student t-tests to examine differences between characteristics of early versus late onset sepsis, and multivariable logistic regression analyses to examine the relationship between select perinatal and neonatal variables on time to blood culture positivity. This research was approved by the institutional Research Ethics Board. A total of 2213 blood cultures were drawn during the study period. 125 positive blood cultures (5.6%) were identified, out of which 20 were deemed as likely contaminant and hence excluded from the analysis. The median time to positivity of blood cultures was 15 hours (Interquartile range 10–22.3 hours). 22% of positive cultures and 1% of all cultures drawn became positive after 24 hours. Only 8% of the positive cultures were positive after 48 hours. Time to positivity of blood cultures did not differ significantly between suspected early onset sepsis versus late onset sepsis (p=0.75). In the logistic regression analysis that included gestational age, clinical chorioamnionitis, timing of sepsis onset, isolated organism, pre-treatment platelet count, and C-reactive protein, only gestational age was significantly inversely associated with time to positivity (Î2=-1.31; p=0.01). Results suggest that with the 48-hour empiric antibiotic rule, a large number of neonates potentially receive unnecessary doses of antibiotics as only 1% of all blood cultures become positive after 24 h. A shorter duration of empiric antibiotic therapy may be considered to reduce unnecessary antibiotic exposure in neonates and development of antibiotic resistance in the NICU.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,009 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».