Early stoppage of antibiotics in blood culture negative term suspected early onset sepsis and their 7 days outcome

Manas Ranjan Upadhyay, Kiran Chandra Pankaj, Sristi Ganguly, Mangal Charan Murmu


Introduction: Sepsis is the commonest cause of neonatal mortality; it is responsible for about 30-50% of the total neonatal deaths in developing countries. It is estimated that up to 20% of neonates develop sepsis and approximately 1% die of sepsis related causes. Despite receiving extensive care in hospitals in the form of ventilator and inotropic support in intensive care set up, 2-3% of term and 20-30% of preterm infants still die of early onset sepsis (EOS). Clinical suspicion therefore frequently leads to empirical antibiotic therapy in uninfected infants. Treating an uninfected infant for 5 to 7 days means disrupting maternal bonding and breast feeding for an extended period of time, pain and distress from starting IVs, exposing the infant to drugs with potential toxicities, fostering the development of antibiotic resistant flora, and increasing the probability that the infant will experience a more serious morbidity later in the course of hospitalization. Material and Method: The study cohort consisted of the all term babies hospitalised with early onset sepsis to the S.C.B M.C.H and S.V.P.P.G.I.P, Cuttack from October 2016 to September 2018. Result: Out of total 186 neonates with suspected early onset sepsis, majority were male (64%) and 93% presented within 24 hours of life. The most common perinatal risk factor noted was low birth weight (43%) followed by perinatal asphyxia (24.2%). 96.2% of the neonates were symptomatic at the time of admission; the most common symptom being respiratory distress (73.6%). The blood culture was positive in 25.8% babies. The incidence of culture positive sepsis in symptomatic babies was 27%. None of the asymptomatic babies were culture positive. Only 49% of screen positive babies were blood culture positive. Antibiotics were stopped in 133 babies and unnecessary use of antibiotics was reduced by 82.6%. No sepsis related adverse outcome was noted in 7 days following stoppage of antibiotics. Conclusion: It is safe to stop antibiotics in term EOS babies if the 48 hour blood culture is negative and baby is asymptomatic.

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Neonatal and Perinatal Mortality. WHO/FRH MSM/ 967 Geneva;1996.(https://apps.who.int/iris/ bitstream/ 10665/ 43444/1/9241563206_eng.pdf)

Stoll BJ. The global impact of neonatal infection. Clin Perinatol. 1997;24(1):1–21.doi: https://doi.org/ 10. 1016/S0095-5108(18)30181-7

Vergnano S, Sharland M, Kazembe P, Wansambo CM, Heath PT. Neonatal sepsis. An international perspective. Arch. Dis. Child. Fetal Neonatal Ed., 2005; 90 (3): F220- F224. doi: 10.1136/adc.2002.022863

Lawn JE, Cousens S, Zupan J; Lancet Neonatal Survival Steering Team 4 million neonatal deaths: when? Where? Why? Lancet. 2005;365(9462):891-900. doi: https://doi.org/10.1016/S0140-6736(05)71048-5

Thaver D, Zaidi AK. Burden of neonatal infections in developing countries: a review of evidence from community-based studies. Pediatr Infect Dis J. 2009; 28 (1 Suppl):S3-S9.doi: 10.1097/INF.0b013e 3181958755.

Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet. 1999;354(9194):1955-1961. doi: https://doi.org/10.1016/S0140-6736(99)03046-9

Stoll BJ, Hansen NI, Sánchez PJ, Faix RG, Poindexter BB, Van Meurs KP, et al; Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues. Pediat. 2011;127(5):817-26.doi: 10.1542/peds.2010-2217.

Phares CR, Lynfield R, Farley MM, Mohle-Boetani J, Harrison LH, Petit S, et al; Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. JAMA. 2008;299(17):2056-2065. doi: 10. 1001/ jama.299.17.2056.

Gordon AL, English M, Tumaini Dzombo J, Karisa M, Newton CR. Neurological and developmental outcome of neonatal jaundice and sepsis in rural Kenya. Trop Med Int Health. 2005;10(11):1114-20.doi: https:// doi. org/10.1111/j.1365-3156.2005.01496.x

Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, Hintz SR, Vohr B, Higgins RD; Neurodevelop-mental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA. 2004;292(19):2357-65. doi:10.1001/ jama. 292.19.2357

Long SS, Pickering LK, Prober CG. Principles and practice of pediatric infectious disease. Elsevier Health Sciences; 4th ED 2012. PP-707-712.

Escobar GJ, The Neonatal “Sepsis Work-up”: Personal Reflections on the Development of an Evidence- Based Approach Toward Newborn Infections in a Managed Care Organization. Pediat. 1999;103(1): 360–373.

Polin RA; Committee on Fetus and Newborn. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics. 2012;129(5): 1006-15. doi: 10.1542/peds.2012-0541.

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: 10.3389/fped.2018.00285

Schulfer A, Blaser MJ. Risksof AntibioticExposures EarlyinLifeontheDevelopingMicrobiome. PLoS Pathog. 2015;11(7):e1004903.doi:10.1371/journal.ppat. 100490.

Gerdes JS, Polin R. Early diagnosis and treatment of neonatal sepsis. Indian J Pediatr 1998;65(1):63-78.doi: https://doi.org/10.1007/BF02849696

Gotoff SP, Behrman RE. Neonatal septicemia. J. Paed. 1970:76(1):142-153.

Bhakoo ON. Neonatal bacterial infections at Chandigarh-A decade of experience. Indian J Pediatr 1980; 47(5):419–424.doi: https://doi.org/10.1007/BF 02759845

Kari A. Simonsen, Ann L. Anderson-Berry, Shirley F. Delair, H. Dele Davies . Early-Onset Neonatal Sepsis doi:10.1128/CMR.00031-13.

Buch A, Srivastava, Kumar H, Jadhav P. Evaluation of hematological profile in early diagnosis of clinically suspected cases of neonatal sepsis. Int J BAMS. 2011; 1(1):1-6.

Edwards M. Postnatal Bacterial Infections. In: Martin RJ, Fanaroff AA, Walsh MC, editors. Fanaroff and Martin's neonatal-perinatal medicine: diseases of the fetus and infant. 9th ed. Philadelphia: Saunders/ Elsevier; 2011. pp. 793–830.

Chandra A, Rao MN, Srinivas M and Shyamala S. Rapid diagnostic tests in neonatal septicemia. Indian J Pediatr.1988;55(6):947-953. doi:10.1007/bf02727835

Antoinette BMW and Flora DIP. Clinical correlation of neonatal and maternal haematological parameters as predictors of neonatal sepsis. Pediatric Infect Dis Soc Philippines J. 2005;9;(2):36-43.

RajarshiBasu, Shyamal Kumar Bandyopadhyay, Study on Correlation between Sepsis Screening and Blood Culture in Neonatal Sepsis; IOSR-JDMS. 2014; 13(5):52-56.

Hassan HR, Gohil JR, Desai R, Mehta RR, Chaudhary VP. Correlation of blood culture results with the sepsis score and sepsis screen in the diagnosis of early-onset neonatal septicemia. J Clinic Neonatol. 2016;5(3):193-198. DOI: 10.4103/2249-4847.191263

K. Padma Malini, Sunethri Padma, N. Srivani, Chaitanya Kumari, O. Shravan Kumar, J. Venkateswara Rao.Application and correlation of hematological scoring system and serum prolactin levels in early diagnosis of neonatal sepsis – 3 year study. IAIM. 2016; 3 (11):36-45.

Piyush G, Murali MV, Faridi MMA, Caul PP, Ramachandran VG, V Talwar. Clinical profile of Klebsiella septicemia in neonates. Indian JPediat. 1993; 60 (4):565-572.

Shetty SMV, Moses GL, Subramanian L and Balagopal RV. A critical analysis of septicemia in infancy. Indian J Paediatr. 1976;13;(1):443-446.

Philip Alistair GS, Hewitt JR. Early diagnosis of neonatal sepsis. Pediatr 1980;65(5):1036-1041.

KhatuaSP, Das AK, Chatterjee BD, Khatua S, Ghose B, Saha A. Neonatal septicemia. Indian J Pediatr. 1986; 53(4):509-514.doi:https://doi.org/10.1007/BF027 49537

Sinha N, Deb A, Mukherjee AK. Septicemia in neonate and early infancy. Indian J Pediatr. 1986;53 (2):249-256.doi: https://doi.org/10.1007/BF02748516

Patil M, Bendigeri J. Clinico-epidemiological study of Acne Vulgaris in Southern India. Int J Biomed Res. 2015;6(07):509-511. 509. doi: 10.7439/ijbr

Mathur NB, Khalil A, Sarkar R, Puri KK. Mortality in neonatal septicemia with involvement of mother in management. Indian Pediatr. 1991;28(11):1259-1263.

Investigators of the Delhi Neonatal Infection Study (DeNIS) collaboration. Characterisation and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: a cohort study; Lancet Glob Health 2016; 4: e752–60. doi: 10.1016/S2214-109X(16)30148-6.

Singh M, Narang A, Bhakoo ON. Predictive perinatal score in the diagnosis of neonatal sepsis. J Trop Pediatr. 1994;40(6):365-8.doi: 10.1093/tropej/ 40.6.365.

Jajoo M, Kapoor K, Garg LK, Manchanda V, Mittal SK.To Study the Incidence and Risk Factors of Early Onset Neonatal Sepsis in an Out born Neonatal Intensive Care Unit of India. J Clinic Neonatol. 2015; 4(2):91-95. doi: 10.4103/2249-4847.154106

Agarwal M, Chathurvedi P, Dey SK, Narang P, Coagulase negative staphylococcal septicemia in newborn. Indian Pediatr. 1990;27(2):163-169.

Kishore K, Deorari AK, Singh M, Bhujwala RA. Early onset neonatal sepsis: Vertical transmission from maternal genital tract. Indian Pediatr. 1987; 24(1):45-8.

Anand NK, Gupta AK, Mohan M,Lamba IMS, Gupta R, Shrivastava L.Coagulase negative septicemia in newborn. Indian Pediatr. 1991;28:1241-1248.

Mehrotra N, Kumar A, Chansoria M, Kaul KK. Neonatal sepsis, correlation of maternal and neonatal factors to positive blood. cultures. Indian Pediatr 1985; 22 (4):275-280.

Kondle KV, T. Clement Manohar, Clinical study of neonatal septicemiawith reference to early indicators of sepsis in NICU, PIMS. PediatrEducat Res. 2017;5 (3):197-202.

Sharma A, Krishna Kutty CV, Sabharwal U, Sushila and Mohan H (1993). Evaluation of sepsis screen for diagnosis of neonatal septicemia. Indian J Pediatr. 1993; 60(4):559-563.

Lee YH, Kim SW, Kim MH, Choi YS. Predictive factors and its usefulness in early diagnosis of neonatal sepsis. J Korean Soc Neonatol. 1997;4(2):195-204.

Joshi SG, Ghole VS, Niphadkar KB. Neonatal Gram-Negative Bacteremia. Indian J Pediatr 2000;67 (1):27-32.doi: https://doi.org/10.1007/ BF02802632

NNPD Report of the National Neonatal Perinatal Database (National Neonatology Forum) 2002-03.

Hussein AB, Khaled MAR. CRP in neonate with suspected septicemia. Rawal Med J. 2007;32(1):24-27.

Vandana G, Magar LR, Praveen, Devi K. Haematological Profile in Neonatal Septiceamia; IOSR-JDMS. 2017; 16(4): 11-17. doi: 10.9790 /0853-1604091117


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