48
hours. Of cultures that became positive >48 hours, 7 of 8 grew coagulase-negative
staphylococci; 4 were contaminants.NeoNotes Journal Club
Andrew B. Kairalla MD, Editor
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Sensitivity of 48-hour Cultures
Should Antibiotics be Discontinued at 48 Hours for Negative Late-Onset Sepsis Evaluations in the Neonatal Intensive Care Unit?
Kaiser JR, Cassat JE, and Lewno MJ. Journal of Perinatology, September 2002, 22 (6):445-447.Objective: To establish the appropriate length of antibiotic therapy for negative late-onset sepsis evaluations in the neonatal intensive care unit (NICU), based on time to detection of positive bacterial cultures.
Study Design: Culture results from late-onset sepsis evaluations between January 1, 1994 and June 30, 1998 from outborn neonates at the Arkansas Children's Hospital NICU were retrospectively reviewed. The time period from specimen collection to notification of NICU personnel was calculated for positive cultures.
Results: There were 2783 blood, 724 urine, and 294
cerebrospinal fluid cultures obtained, of which 10.2%, 6.6%, and 5.4%, respectively, were
positive for bacterial isolates. Of positive cultures, 98% had a time to detection 48
hours. Of cultures that became positive >48 hours, 7 of 8 grew coagulase-negative
staphylococci; 4 were contaminants.
Conclusion: Discontinuing antibiotic therapy for neonates with possible late-onset sepsis and negative cultures at 48 hours is appropriate and is now standard care in our NICU.
Comment: This study confirms that 99% of significant positive cultures will grow within the first 48 hours of incubation. There is little to be gained by waiting for 72-hour culture results before stopping antibiotics. ABK.
Date: 31 Aug 2002
Time: 14:30:12
Together with blood culture, we are using CRP for both early and late onset neonatal
sepsis. Antibiotics will be stopped once 2 CRP's (24 hours apart) are normal and no
positive culture reported up to 48 hours. This study's result do concern me for the
delayed detection of CNS sepsis. It is well known that they may not trigger a sufficient
CRP response as well. As CNS (especially methicillin resistant CNS) may cause
significant morbidity and mortality in preterm infants, is it safe to stop antibiotics by
48 hours?
UserName: Brian Ho
Institution: Pamela Youde Hospital, Hong Kong
email: brianyon@netvigator.com
Date: 02 Sep 2002
Time: 13:51:42
I'm very surprised at the conculsions of this article. Coag-neg staph is probably
the most common etiology in our NICU for late-onset sepsis in babies with central lines.
I think 48-hour culture results are OK for early-onset sepsis, but I would not
trust them for late-onset.
UserName: Paul Hinkes, M. D.
Institution: Providence St Joseph Medical Center
telephone: 818-847-3232
email: preemys@msn.com
Date: 26 Sep 2002
Time: 19:03:22
This article reflects our practice for some years and does describe a relatively robust
way of balancing concerns about missed infection with concerns about over-use of
antibiotics ( a very significant problem, which we may come to regret ).
I agree that CNS can take longer to grow and may show a slow CRP response, but do not
share the concerns expressed about the inadequacy of a 48 hour course in the treatment and
investigation of nosocomial sepsis
To me the critical point is the well baby-sick baby distinction. The point of commencing
antibiotics on suspicion is to avoid death or harm from overwhelming, rapidly progressive
infection. The relatively rare CONS bacteraemia with late growth is not usually associated
with catastrophic illness. If the child were still unwell or had other suggestive indices,
one would not cease. If the child were well, but bacteraemic, due diligence/observation
will give one a second chance.
Best Wishes
UserName: Andrew Watkins
Institution: Mercy Hospital for Women
telephone: -61-3-9270 2222
email: awatkins@mercy.com.au
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