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Clinical and Microbiologic Characteristics of Early-onset Sepsis Among Very Low Birth Weight Infants: Opportunities for Antibiotic Stewardship.

Abstract Most very low birth weight (VLBW, birth weight <1500 g) infants receive empiric antibiotics for risk of early-onset sepsis (EOS). The objective of this study was to determine the characteristics of VLBW infants with culture-confirmed EOS at a single center during 25 years and to identify opportunities for antibiotic stewardship.
PMID
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Clinical and Microbiologic Characteristics of Early-Onset Sepsis Among VLBW Infants: Opportunities for Antibiotic Stewardship.

Authors

Mayor MeshTerms

Infant, Very Low Birth Weight

Keywords
Journal Title the pediatric infectious disease journal
Publication Year Start




PMID- 28403049
OWN - NLM
STAT- MEDLINE
DA  - 20170413
DCOM- 20170420
LR  - 20170420
IS  - 1532-0987 (Electronic)
IS  - 0891-3668 (Linking)
VI  - 36
IP  - 5
DP  - 2017 May
TI  - Clinical and Microbiologic Characteristics of Early-onset Sepsis Among Very Low
      Birth Weight Infants: Opportunities for Antibiotic Stewardship.
PG  - 477-481
LID - 10.1097/INF.0000000000001473 [doi]
AB  - BACKGROUND: Most very low birth weight (VLBW, birth weight &lt;1500 g) infants
      receive empiric antibiotics for risk of early-onset sepsis (EOS). The objective
      of this study was to determine the characteristics of VLBW infants with
      culture-confirmed EOS at a single center during 25 years and to identify
      opportunities for antibiotic stewardship. METHODS: Retrospective cohort study
      includes VLBW infants admitted from 1990 to 2015. EOS was defined as isolation of
      a pathogen in blood or cerebrospinal fluid culture obtained at &lt;72 hours of age. 
      Clinical and microbiologic characteristics of EOS case infants were obtained by
      review of medical, laboratory and administrative records. Blood culture,
      antibiotic initiation and maternal discharge code data were available for all
      VLBW infants born between 1999 and 2013. RESULT: One-hundred nine EOS cases
      (20.5/1000 VLBW births) occurred during the study period. Preterm labor, preterm 
      rupture of membranes and/or the obstetrical diagnosis of chorioamnionitis were
      present in 106/109 cases (97%). Obligate anaerobic organisms accounted for 16% of
      cases. Time to culture positivity was 36 hours for 88% and 48 hours for 98% of
      cases. From 1999 to 2013, 97% of VLBW infants were evaluated for EOS and 90%
      administered empiric antibiotics; 22% of these infants were born by cesarean
      section to mothers with preeclampsia and without preterm labor or
      chorioamnionitis and had a 12-fold lower incidence of EOS compared with the
      remaining infants. CONCLUSION: Decisions to initiate and discontinue empiric
      antibiotics among VLBW infants can be informed by the delivery characteristics of
      infected infants and by local microbiologic data.
FAU - Mukhopadhyay, Sagori
AU  - Mukhopadhyay S
AD  - From the *Division of Neonatology, Children's Hospital of Philadelphia, and
      daggerDepartment of Pediatrics, University of Pennsylvania Perelman School of
      Medicine, Philadelphia, Pennsylvania.
FAU - Puopolo, Karen M
AU  - Puopolo KM
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Pediatr Infect Dis J
JT  - The Pediatric infectious disease journal
JID - 8701858
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Age of Onset
MH  - Anti-Bacterial Agents/*therapeutic use
MH  - Blood Culture
MH  - Cesarean Section/statistics &amp; numerical data
MH  - Chorioamnionitis/microbiology/physiopathology/surgery
MH  - Disease Management
MH  - Early Diagnosis
MH  - Female
MH  - Fetal Membranes, Premature Rupture/microbiology/physiopathology/surgery
MH  - Gram-Negative Bacteria/drug effects/growth &amp; development/pathogenicity
MH  - Gram-Negative Bacterial Infections/cerebrospinal fluid/diagnosis/*drug
      therapy/microbiology
MH  - Gram-Positive Bacteria/drug effects/growth &amp; development/pathogenicity
MH  - Gram-Positive Bacterial Infections/cerebrospinal fluid/diagnosis/*drug
      therapy/microbiology
MH  - Humans
MH  - Infant, Newborn
MH  - *Infant, Very Low Birth Weight
MH  - Intensive Care Units, Neonatal
MH  - Male
MH  - Obstetric Labor, Premature/microbiology/physiopathology/surgery
MH  - Pre-Eclampsia/microbiology/physiopathology/surgery
MH  - Pregnancy
MH  - Retrospective Studies
MH  - Sepsis/cerebrospinal fluid/diagnosis/*drug therapy/microbiology
EDAT- 2017/04/14 06:00
MHDA- 2017/04/21 06:00
CRDT- 2017/04/14 06:00
AID - 10.1097/INF.0000000000001473 [doi]
AID - 00006454-201705000-00008 [pii]
PST - ppublish
SO  - Pediatr Infect Dis J. 2017 May;36(5):477-481. doi: 10.1097/INF.0000000000001473.

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