Should antibiotics be discontinued at 48 hours for routine negative sepsis evaluations in the neonatal intensive care unit?

Jeffrey Kaiser, J. E. Cassat, M. J. Lewno

Research output: Contribution to journalArticle

Abstract

The evaluation of sick, hospitalized neonates for possible sepsis is common in the neonatal intensive care unit (NICU). Empiric broad-spectrum antibiotic therapy is usually begun while awaiting blood, urine and cerebrospinal fluid (CSF) culture results. Traditionally, neonatologists at our institution discontinued antibiotics after cultures were negative following a 72-hour incubation period. The purpose of this study is to determine the time to detection of all positive cultures obtained from neonates in the Arkansas Children's Hospital NICU, in order to establish the appropriate length of antibiotic therapy for negative sepsis evaluations. We hypothesized that the time required for most cultures to be detected as positive was ≤ 48 hours. The benefits of reducing empiric therapy to 48 hours are numerous: decreasing antibiotic exposure to a majority of our patients, decreasing the emergence of resistant organisms and reducing costs. Blood cultures were analyzed by the BACTEC 9240 instrument, and urine and CSF cultures using standard techniques. Sepsis evaluations from January 1, 1994 through June 30, 1998 produced 2,783 blood, 724 urine and 294 CSF cultures, of which 283 (10.2%) blood, 48 (6.6%) urine and 15 (5.1%) CSF cultures were positive for bacterial isolates. A "clinical time to detection", defined as the time period from specimen collection to notification of NICU personnel, was calculated for all positive cultures. Of all positive cultures, 97.7% had a clinical time to detection ≤ 48 hours. Of those that became positive after 48 hours, 7 of 8 grew coagulase-negative staphylococci. Based on these data, we believe that decreasing antibiotic therapy from 72 to 48 hours for routine negative sepsis evaluations in the NICU is justified.

Original languageEnglish (US)
JournalJournal of Investigative Medicine
Volume47
Issue number2
StatePublished - Jan 1 1999

All Science Journal Classification (ASJC) codes

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)

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