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Blood culture indications in critically ill neonates : a multicenter prospective cohort study

(2018) EUROPEAN JOURNAL OF PEDIATRICS. 177(10). p.1565-1572
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Abstract
Due to potential lethality of healthcare-associated sepsis (HAS), a low threshold for blood culturing and antimicrobial therapy (ABT) initiation is accepted. We assessed variability in the trigger for blood culturing between three neonatal intensive care units. A multicenter prospective cohort study was conducted. In newborns with suspicion of HAS, 10 predefined clinical signs, nosocomial sepsis (NOSEP) score, C-reactive protein, ABT initiation, and risk factors were registered at time of culturing. Outcome was lab-confirmed HAS, defined according to the NeoKISS-criteria. Two hundred ninety-nine suspected HAS episodes were considered in 212 infants, of which 118 had birth-weight ae<currency> 1500 g; proportion of lab-confirmed HAS per suspected episode was 30/192 (center 1), 28/60 (center 2), and 8/47 (center 3) (p < 0.001). Median C-reactive protein and number of clinical signs at time of culturing differed between centers 1, 2, and 3 (respectively 11 vs. 5 vs. 3 mg/L, p = 0.001; 1 sign [IQR 0-2, center 1] vs. 3 signs [IQR 2-4, centers 2 and 3], p < 0.001). Median NOSEP score at time of culturing was 5 (IQR 3-8, center 1), 5 (IQR 3-9, center 2), and 8 (IQR 5-11, center 3) (p = 0.016). Difference in ABT initiation was noticed (82 vs. 93 vs. 74%, p = 0.05). Conclusion: Center heterogeneity in sampling practice is substantial. Optimizing sampling practice can be recommended.
Keywords
Newborn, Blood culture, Sepsis, Clinical sign, INTENSIVE-CARE-UNIT, BIRTH-WEIGHT INFANTS, LATE-ONSET SEPSIS, NOSOCOMIAL SEPSIS, STREAM INFECTIONS, ANTIBIOTIC USE, RISK-FACTORS, DIAGNOSTIC MARKERS, CLINICAL SIGNS, SURVEILLANCE

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Citation

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Chicago
Verstraete, Evelien, Ludo Mahieu, James d’ Haese, Kris De Coen, Jerina Boelens, Dirk Vogelaers, and Stijn Blot. 2018. “Blood Culture Indications in Critically Ill Neonates : a Multicenter Prospective Cohort Study.” European Journal of Pediatrics 177 (10): 1565–1572.
APA
Verstraete, Evelien, Mahieu, L., d’ Haese, J., De Coen, K., Boelens, J., Vogelaers, D., & Blot, S. (2018). Blood culture indications in critically ill neonates : a multicenter prospective cohort study. EUROPEAN JOURNAL OF PEDIATRICS, 177(10), 1565–1572.
Vancouver
1.
Verstraete E, Mahieu L, d’ Haese J, De Coen K, Boelens J, Vogelaers D, et al. Blood culture indications in critically ill neonates : a multicenter prospective cohort study. EUROPEAN JOURNAL OF PEDIATRICS. 2018;177(10):1565–72.
MLA
Verstraete, Evelien, Ludo Mahieu, James d’ Haese, et al. “Blood Culture Indications in Critically Ill Neonates : a Multicenter Prospective Cohort Study.” EUROPEAN JOURNAL OF PEDIATRICS 177.10 (2018): 1565–1572. Print.
@article{8572635,
  abstract     = {Due to potential lethality of healthcare-associated sepsis (HAS), a low threshold for blood culturing and antimicrobial therapy (ABT) initiation is accepted. We assessed variability in the trigger for blood culturing between three neonatal intensive care units. A multicenter prospective cohort study was conducted. In newborns with suspicion of HAS, 10 predefined clinical signs, nosocomial sepsis (NOSEP) score, C-reactive protein, ABT initiation, and risk factors were registered at time of culturing. Outcome was lab-confirmed HAS, defined according to the NeoKISS-criteria. Two hundred ninety-nine suspected HAS episodes were considered in 212 infants, of which 118 had birth-weight ae{\textlangle}currency{\textrangle} 1500 g; proportion of lab-confirmed HAS per suspected episode was 30/192 (center 1), 28/60 (center 2), and 8/47 (center 3) (p {\textlangle} 0.001). Median C-reactive protein and number of clinical signs at time of culturing differed between centers 1, 2, and 3 (respectively 11 vs. 5 vs. 3 mg/L, p = 0.001; 1 sign [IQR 0-2, center 1] vs. 3 signs [IQR 2-4, centers 2 and 3], p {\textlangle} 0.001). Median NOSEP score at time of culturing was 5 (IQR 3-8, center 1), 5 (IQR 3-9, center 2), and 8 (IQR 5-11, center 3) (p = 0.016). Difference in ABT initiation was noticed (82 vs. 93 vs. 74\%, p = 0.05).
Conclusion: Center heterogeneity in sampling practice is substantial. Optimizing sampling practice can be recommended.},
  author       = {Verstraete, Evelien and Mahieu, Ludo and d{\textquoteright}Haese, James and De Coen, Kris and Boelens, Jerina and Vogelaers, Dirk and Blot, Stijn},
  issn         = {0340-6199},
  journal      = {EUROPEAN JOURNAL OF PEDIATRICS},
  language     = {eng},
  number       = {10},
  pages        = {1565--1572},
  title        = {Blood culture indications in critically ill neonates : a multicenter prospective cohort study},
  url          = {http://dx.doi.org/10.1007/s00431-018-3203-1},
  volume       = {177},
  year         = {2018},
}

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