1887

Abstract

The aim of this study was to determine the time to positivity (TTP) of neonatal blood cultures, to investigate differences between early onset versus late-onset sepsis, and non-proven versus proven sepsis, and to examine differences in TTP by organism type using a retrospective observational study at the Neonatal Intensive Care Unit, Antwerp University Hospital, Belgium. The subjects were 1828 neonates with suspected sepsis who were treated with antimicrobials for at least 3 days. The TTP was recorded for all episodes of suspected sepsis in an approximately 6.5 year period. A total of 2916 blood cultures were collected, of which 437 (15 %) became positive. The overall TTP was 21.33 h (Q–Q 13.17–32.46). The difference between the median TTP in early onset versus late-onset sepsis was 0.83 h (22.00 versus 21.17 h, =0.75). The median TTP for Gram-negative organisms was 11.17 h (Q–Q 8.84–15.67), whereas the median TTP for Gram-positive organisms was 23.59 h (Q–Q 15.29–34.58, <0.001). In Gram-positive isolates, the median TTP for coagulase-negative staphylococci (CNS) was 26.67 h (Q–Q 19.00–38.17), whereas the median TTP for non-CNS was 12.83 h (Q–Q 10.50–18.17, <0.001). The median TTP in proven sepsis was 20.17 h (Q–Q 13.00–30.37), whereas it was 29.67 h (Q–Q 21.17–50.63, <0.001) in non-proven sepsis. TTP of neonatal blood cultures was significantly shorter for Gram-negative organisms. We suggest shortening the total incubation time of neonatal blood cultures to a maximum of 3 days. However, blood cultures collected in infants <72 h of age might require a longer incubation time. According to our results, it may be safe to narrow the antimicrobial spectrum to solely target Gram-positive bacteria when the culture is still negative after 48 h, and to cease antimicrobial therapy when the culture is still negative after 72 h in clinically well infants.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.020651-0
2011-04-01
2024-03-29
Loading full text...

Full text loading...

/deliver/fulltext/jmm/60/4/446.html?itemId=/content/journal/jmm/10.1099/jmm.0.020651-0&mimeType=html&fmt=ahah

References

  1. Bizzarro M. J., Raskind C., Baltimore R. S., Gallagher P. G. 2005; Seventy-five years of neonatal sepsis at Yale: 1928–2003. Pediatrics 116:595–602 [CrossRef]
    [Google Scholar]
  2. Burke C. 2009; Perinatal sepsis. J Perinat Neonatal Nurs 23:42–51 [CrossRef]
    [Google Scholar]
  3. Doern G. V., Barton A., Rao S. 1998; Controlled comparative evaluation of BacT/Alert FAN and ESP 80A aerobic media as means for detecting bacteremia and fungemia. J Clin Microbiol 36:2686–2689
    [Google Scholar]
  4. Garcia-Prats J. A., Cooper T. R., Schneider V. F., Stager C. E., Hansen T. N. 2000; Rapid detection of microorganisms in blood cultures of newborn infants utilizing an automated blood culture system. Pediatrics 105:523–527 [CrossRef]
    [Google Scholar]
  5. Gardner S. L. 2009; Sepsis in the neonate. Crit Care Nurs Clin North Am 21:121–141 [CrossRef]
    [Google Scholar]
  6. Gibson A. T. 2007; Outcome following preterm birth. Best Pract Res Clin Obstet Gynaecol 21:869–882 [CrossRef]
    [Google Scholar]
  7. Guerti K., Ieven M., Mahieu L. 2007; Diagnosis of catheter-related bloodstream infection in neonates: a study on the value of differential time to positivity of paired blood cultures. Pediatr Crit Care Med 8:470–475 [CrossRef]
    [Google Scholar]
  8. Haque K. N. 2005; Definitions of bloodstream infection in the newborn. Pediatr Crit Care Med 6:S45–S49 [CrossRef]
    [Google Scholar]
  9. Hurst M. K., Yoder B. A. 1995; Detection of bacteremia in young infants: is 48 hours adequate?. Pediatr Infect Dis J 14:711–713 [CrossRef]
    [Google Scholar]
  10. Ieven M., Verhoeven J., Pattyn S. R., Goossens H. 1995; Rapid and economical method for species identification of clinically significant coagulase-negative staphylococci. J Clin Microbiol 33:1060–1063
    [Google Scholar]
  11. Janjindamai W., Phetpisal S. 2006; Time to positivity of blood culture in newborn infants. Southeast Asian J Trop Med Public Health 37:171–176
    [Google Scholar]
  12. Jardine L., Davies M. W., Faoagali J. 2006; Incubation time required for neonatal blood cultures to become positive. J Paediatr Child Health 42:797–802 [CrossRef]
    [Google Scholar]
  13. Krisher K. K., Gibb P., Corbett S., Church D. 2001; Comparison of the BacT/Alert PF pediatric FAN blood culture bottle with the standard pediatric blood culture bottle, the Pedi-BacT. J Clin Microbiol 39:2880–2883 [CrossRef]
    [Google Scholar]
  14. Kristóf K., Kocsis E., Nagy K. 2009; Clinical microbiology of early-onset and late-onset neonatal sepsis, particularly among preterm babies. Acta Microbiol Immunol Hung 56:21–51 [CrossRef]
    [Google Scholar]
  15. Kumar Y., Qunibi M., Neal T. J., Yoxall C. W. 2001; Time to positivity of neonatal blood cultures. Arch Dis Child Fetal Neonatal Ed. 85F182–F186 [CrossRef]
  16. Kurlat I., Stoll B. J., McGowan J. E. Jr 1989; Time to positivity for detection of bacteremia in neonates. J Clin Microbiol 27:1068–1071
    [Google Scholar]
  17. Leroyer A., Bedu A., Lombrail P., Desplanques L., Diakite B., Bingen E., Aujard Y., Brodin M. 1997; Prolongation of hospital stay and extra costs due to hospital-acquired infection in a neonatal unit. J Hosp Infect 35:37–45
    [Google Scholar]
  18. Mahieu L. M., Buitenweg N., Beutels P., De Dooy J. J. 2001; Additional hospital stay and charges due to hospital-acquired infections in a neonatal intensive care unit. J Hosp Infect 47:223–229 [CrossRef]
    [Google Scholar]
  19. Mahieu L. M., De Muynck A. O., De Dooy J. J., Laroche S. M., Van Acker K. J. 2000; Prediction of nosocomial sepsis in neonates by means of a computer-weighted bedside scoring system (NOSEP score). Crit Care Med 28:2026–2033 [CrossRef]
    [Google Scholar]
  20. Mullett M. D., Cook E. F., Gallagher R. 1998; Nosocomial sepsis in the neonatal intensive care unit. J Perinatol 18:112–115
    [Google Scholar]
  21. Pattyn S. R., Sion J. P., Verhoeven J. 1990; Evaluation of the LOGIC system for the rapid identification of members of the family Enterobacteriaceae in the clinical microbiology laboratory. J Clin Microbiol 28:1449–1450
    [Google Scholar]
  22. Pauli I. Jr, Shekhawat P., Kehl S., Sasidharan P. 1999; Early detection of bacteremia in the neonatal intensive care unit using the new BACTEC system. J Perinatol 19:127–131 [CrossRef]
    [Google Scholar]
  23. Rowley A. H., Wald E. R. 1986; Incubation period necessary to detect bacteremia in neonates. Pediatr Infect Dis 5:590–591 [CrossRef]
    [Google Scholar]
  24. Van den Hoogen A., Gerards L. J., Verboon-Maciolek M. A., Fleer A., Krediet T. G. 2010; Long-term trends in the epidemiology of neonatal sepsis and antibiotic susceptibility of causative agents. Neonatology 97:22–28 [CrossRef]
    [Google Scholar]
  25. Vinod Kumar C. S., Neelagaud Y. F. 2005; Incubation period for culture positivity to detect septicaemia in neonates. Indian J Med Microbiol 23:270–271
    [Google Scholar]
  26. Zaidi A. K., Thaver D., Ali S. A., Khan T. A. 2009; Pathogens associated with sepsis in newborns and young infants in developing countries. Pediatr Infect Dis J 28:S10–S18 [CrossRef]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.020651-0
Loading
/content/journal/jmm/10.1099/jmm.0.020651-0
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error