Culture negative sepsis in neonate in a level III NICU of a community hospital in Brooklyn New York
DOI:
https://doi.org/10.18203/2349-3291.ijcp20250079Keywords:
Culture negative sepsis, Community hospital, Neonatal intensive care unitAbstract
Background: Neonates often diagnosed with possible sepsis without any evidence of bacterial cause, known as “culture negative sepsis (CnS)”. Most data on neonatal sepsis focuses on culture proven sepsis but large number of neonates receives antibiotic for CnS and its epidemiological data is not accurately represented. Studies suggest that its incidence exceeds incidence of proven sepsis by 16 folds in United states and 50-fold in resource limited settings. According to recent estimates CnS contributes to 20% antibiotic usage in Neonatal intensive care units (NICUs). It is linked to adverse neurodevelopmental outcomes. We aim to identify the incidence and frequency of CnS in a community NICU.
Methods: It is a retrospective observational study between November 2023 to March 2024 in a level III NICU. Neonates admitted during 1st January 2023 till 30th June 2023 and required antibiotic were included. IRB approval was obtained. Data collected for gestational age, gender, diagnosis, blood culture, indication, type, number of days of antibiotic, length of stay, invasive device and duration, birth weight, blood culture and comorbid condition. Data was analyzed using SPSS 22.0. Frequencies and percentages calculated and Pearson Chi-square used to assess correlations, p<0.05 considered statistically significant.
Results: The 95 neonates enrolled. Incidence of CNS was 64%. The 15% patients require invasive devices. Most common indication for antibiotic use was clinical SIRS (75%). The 49% of babies had comorbidities and most common comorbidity was prematurity (47%).
Conclusions: CnS has high incidence in community hospital NICU’s then reported in literature.
Metrics
References
Shane AL, Sanchez PJ, Stoll BJ. Neonatal sepsis. Lancet. 2017;390(10104):1770-80. DOI: https://doi.org/10.1016/S0140-6736(17)31002-4
Klingenberg C, Kornelisse RF, Buonocore G, Maier RF, Stocker M. Culture-Negative Early-Onset Neonatal Sepsis-At the Crossroad Between Efficient Sepsis Care and Antimicrobial Stewardship. Front Pediatr. 2018;6:285.
Cantey JB, Prusakov P. A proposed framework for the clinical management of neonatal “Culture negative Sepsis”. J Pediatr. 2022;244:203-11. DOI: https://doi.org/10.1016/j.jpeds.2022.01.006
Jiang S, Yang Z, Shan R, Zhang Y, Yan W, Yang Y, et al. Neonatal outcomes following culture negative late onset sepsis among preterm infants. Pediatr Infect Dis J. 2020;39:232-8 . DOI: https://doi.org/10.1097/INF.0000000000002558
Piantino JH, Schreiber MD, Alexander K, Hageman J. Culture Negative Sepsis and systemic inflammatory response syndrome in Neonates. Neoreviews. 2013;14(6):e294-305.
Hornik CP, Benjamin DK, Becker KC, Benjamin Jr DK, Li J, Clark RH, et al. Use of the complete blood cell count in late-onset neonatal sepsis. Pediatr Infect Dis J. 2012;31:803-7. DOI: https://doi.org/10.1097/INF.0b013e31825691e4
Brown JVE, Meader N, Wright K, Cleminson J, McGuire W. Assessment of C-reactive protein diagnostic test accuracy for late-onset infec- tion in newborn infants: a systematic review and meta-analysis. JAMA Pediatr. 2020;174:260-8. DOI: https://doi.org/10.1001/jamapediatrics.2019.5669
Pontrelli G, De Crescenzo F, Buzzetti R, Jenkner A, Balduzzi S, Calo Carducci F, et al. Accuracy of serum procalcitonin for the diagnosis of sepsis in neonates and children with systemic inflammatory syndrome: a meta-analysis. BMC Infect Dis. 2017;17:302. DOI: https://doi.org/10.1186/s12879-017-2396-7
Turner C, Turner P, Hoogenboom G, Aye Mya Thein N, McGready R, Phakaudom K, et al. A three-year descriptive study of early onset neonatal sepsis in a refugee population on the Thailand Myanmar border. BMC Infect Dis. 2013;13:601. DOI: https://doi.org/10.1186/1471-2334-13-601
Klingenberg C, Kornelisse RF, Buonocore G, Maier RF, Stocker M. Culture negative early onset neonatal sepsis-at the crossroad between efficient sepsis care and antimicrobial stewardship. Front Pediatr. 2018;6:285. DOI: https://doi.org/10.3389/fped.2018.00285
Prusakov P, Goff DA, Wozniak PS, Cassim A, Scipion CEA, Urzua S, et al. A global point prevalence survey of antimicrobial use in neonatal intensive care units: the no-more-antibiotics and resistance (NO-MAS- R) study. E Clin Med. 2021;32:100727. DOI: https://doi.org/10.1016/j.eclinm.2021.100727
Cantey JB, Wozniak PS, Pruszynski JE, Sanchez PJ. Reducing unneces- sary antibiotic use in the neonatal intensive care unit (SCOUT): a prospective interrupted time-series study. Lancet Infect Dis. 2016;16:1178-84. DOI: https://doi.org/10.1016/S1473-3099(16)30205-5
Mukhopadhyay S, Puopolo KM, Hansen NI, Lorch SA, DeMauro SB, Greenberg RG, et al. Neurodevelopmental outcomes following neonatal late-onset sepsis and blood culture negative conditions. Arch Dis Child Fetal Neonatal Ed. 2021;106:467-73. DOI: https://doi.org/10.1136/archdischild-2020-320664
Schlapbach LJ, Aebischer M, Adams M, Natalucci G, Bonhoeffer J, Latzin P, et al. Impact of sepsis on neurodevelopmental outcome in a Swiss National Cohort of extremely premature infants. Pediatrics. 2011;128:e348-57. DOI: https://doi.org/10.1542/peds.2010-3338
Joseph B. Cantey, Stephen D. Baird; Ending the Culture of Culture-Negative Sepsis in the Neonatal ICU. Pediatr. 2017;140(4):e20170044. DOI: https://doi.org/10.1542/peds.2017-0044
Piantino J, Schreiber M, Alexander K, Hageman J. Culture Negative Sepsis. NeoReviews. 2013;14:e294. DOI: https://doi.org/10.1542/neo.14-6-e294
Wong DM, Ruby RE, Dembek KA, Barr BS, Reuss SM, Magdesian KG, et al. Evaluation of updated sepsis scoring systems and systemic inflammatory response syndrome criteria and their association with sepsis in equine neonates. J Vet Intern Med. 2018;32(3):1185-93. DOI: https://doi.org/10.1111/jvim.15087
Park J, De Beritto T, Douglas A, Barbara B, Kenneth AA, Joseph RH. Culture negative sepsis: a national survey of variations in clinical practice. J Perinatol. 2024;44(12):1805-6. DOI: https://doi.org/10.1038/s41372-024-02140-w