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Evaluating the Use of Neonatal Colonization Screening for Empiric Antibiotic Therapy of Sepsis and Pneumonia. Antibiotics (Basel) 2023; 12:antibiotics12020189. [PMID: 36830099 PMCID: PMC9952289 DOI: 10.3390/antibiotics12020189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/18/2023] Open
Abstract
(1) Background: Since 2013, weekly screening for multidrug-resistant Gram-negative (MDRGN) bacteria has been performed in German neonatal intensive care units (NICU). National guidelines recommend considering these colonization analyses for antibiotic treatment regimens. Our retrospective single center study provides insight into the clinical dichotomy of bacterial colonization and infection rates in neonates. (2) Methods: We analyzed microbiological data of neonates admitted to our tertiary level NICU over nine years. Colonization with MDRGN/Serratia marcescens (SERMA) was compared to microbiological findings in sepsis and pneumonia. (3) Results: We analyzed 917 blood and 1799 tracheal aspirate samples. After applying criteria from the Nosocomial Infection Surveillance for Neonates (NEO-KISS), we included 52 and 55 cases of sepsis and pneumonia, respectively; 19.2% of sepsis patients and 34.5% of pneumonia patients had a prior colonization with MDRGN bacteria or SERMA. In these patients, sepsis was not attributable to MDRGN bacteria yet one SERMA, while in pneumonias, ten MDRGN bacteria and one SERMA were identified. We identified late-onset pneumonia and cesarean section as risk factors for MDRGN/SERMA acquisition. (4) Conclusions: Colonization screening is a useful tool for hygiene surveillance. However, our data suggest that consideration of colonization with MDRGN/SERMA might promote extensive use of last resort antibiotics in neonates.
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2
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Risikofaktoren für Schließungen von neonatologischen und pädiatrischen Stationen in nosokomialen Ausbrüchen. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01667-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Zusammenfassung
Hintergrund
Im Fall eines nosokomialen Ausbruchs (NA) in der Pädiatrie und Neonatologie wird neben einer Vielzahl weiterer Maßnahmen mintunter die gesamte Station für Neuaufnahmen geschlossen. Dies ist infektionsprophylaktisch zwar oft effektiv, jedoch ökonomisch oft auch sehr nachteilig. Wichtig sind daher Kenntnisse darüber, wann eine solche Schließung sehr wahrscheinlich unvermeidbar ist, um diese dann frühestmöglich durchzuführen.
Ziel der Arbeit
Ermittlung von Charakteristika, die eine Schließung letztlich wahrscheinlich machen.
Material und Methoden
Systematische Literaturrecherche der Worldwide Outbreak Database und weiterer internationaler Datenbanken zu NA mit und ohne Schließung.
Ergebnisse
Es wurden 198 NA aus der Pädiatrie (darunter 25 NA mit und 173 NA ohne Schließung) sowie weitere 413 NA aus der Neonatologie (darunter 52 NA mit und 361 NA ohne Schließung) eingeschlossen. In 446 dieser 611 NA waren auch Intensivstationen (ITS) betroffen. Insgesamt waren 16.107 Patienten betroffen und es ereigneten sich 3155 Infektionen mit 1542 Todesfällen. Die Gesamtdauer der NA betrug dabei 2 bis 4380 Tage; sofern erfolgt, betrug die Dauer der Schließung 2 bis 210 Tage. Die am häufigsten nachgewiesenen Erreger in Ausbrüchen mit Schließung waren S. marcescens, E. cloacae und K. pneumoniae. Die Beteiligung einer ITS sowie hohe Fallzahlen korrelierten signifikant mit der Wahrscheinlichkeit für eine spätere Schließung.
Diskussion
Insbesondere für die Neonatologie wird bei der Beteiligung einer ITS an einem NA empfohlen, eine Schließung des Bereiches frühzeitig zu erwägen. Zudem kann in NA die Definition lokal festgelegter Schwellenwerte für Patientenzahlen, bei deren Überschreiten bestimmte Hygienemaßnahmen, wie z. B. die Schließung der Station, initiiert werden, sinnvoll sein.
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Campestre C, De Luca V, Carradori S, Grande R, Carginale V, Scaloni A, Supuran CT, Capasso C. Carbonic Anhydrases: New Perspectives on Protein Functional Role and Inhibition in Helicobacter pylori. Front Microbiol 2021; 12:629163. [PMID: 33815311 PMCID: PMC8017301 DOI: 10.3389/fmicb.2021.629163] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/22/2021] [Indexed: 12/12/2022] Open
Abstract
Our understanding of the function of bacterial carbonic anhydrases (CAs, EC 4.2.1.1) has increased significantly in the last years. CAs are metalloenzymes able to modulate CO2, HCO3 - and H+ concentration through their crucial role in catalysis of reversible CO2 hydration (CO2 + H2O ⇄ HCO3 - + H+). In all living organisms, CA activity is linked to physiological processes, such as those related to the transport and supply of CO2 or HCO3 -, pH homeostasis, secretion of electrolytes, biosynthetic processes and photosynthesis. These important processes cannot be ensured by the very low rate of the non-catalyzed reaction of CO2 hydration. It has been recently shown that CAs are important biomolecules for many bacteria involved in human infections, such as Vibrio cholerae, Brucella suis, Salmonella enterica, Pseudomonas aeruginosa, and Helicobacter pylori. In these species, CA activity promotes microorganism growth and adaptation in the host, or modulates bacterial toxin production and virulence. In this review, recent literature in this research field and some of the above-mentioned issues are discussed, namely: (i) the implication of CAs from bacterial pathogens in determining the microorganism growth and virulence; (ii) the druggability of these enzymes using classical CA inhibitors (CAIs) of the sulfonamide-type as examples; (iii) the role played by Helicobacter pylori CAs in the acid tolerance/adaptation of the microbe within the human abdomen; (iv) the role of CAs played in the outer membrane vesicles spawned by H. pylori in its planktonic and biofilm phenotypes; (v) the possibility of using H. pylori CAIs in combination with probiotic strains as a novel anti-ulcer treatment approach. The latter approach may represent an innovative and successful strategy to fight gastric infections in the era of increasing resistance of pathogenic bacteria to classical antibiotics.
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Affiliation(s)
- Cristina Campestre
- Department of Pharmacy, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Viviana De Luca
- Department of Biology, Agriculture and Food Sciences, National Research Council (CNR), Institute of Biosciences and Bioresources, Naples, Italy.,Proteomics and Mass Spectrometry Laboratory, Institute for the Animal Production System in the Mediterranean Environment, National Research Council (ISPAAM-CNR), Naples, Italy
| | - Simone Carradori
- Department of Pharmacy, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Rossella Grande
- Department of Pharmacy, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Vincenzo Carginale
- Department of Biology, Agriculture and Food Sciences, National Research Council (CNR), Institute of Biosciences and Bioresources, Naples, Italy
| | - Andrea Scaloni
- Proteomics and Mass Spectrometry Laboratory, Institute for the Animal Production System in the Mediterranean Environment, National Research Council (ISPAAM-CNR), Naples, Italy
| | - Claudiu T Supuran
- Section of Pharmaceutical and Nutraceutical Sciences, Polo Scientifico, Department of NEUROFARBA, University of Florence, Sesto Fiorentino, Italy
| | - Clemente Capasso
- Department of Biology, Agriculture and Food Sciences, National Research Council (CNR), Institute of Biosciences and Bioresources, Naples, Italy
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Härtel C, Faust K, Fortmann I, Humberg A, Pagel J, Haug C, Kühl R, Bohnhorst B, Pirr S, Viemann D, Simon A, Zemlin M, Poralla S, Müller A, Köstlin-Gille N, Gille C, Heckmann M, Rupp J, Herting E, Göpel W. Sepsis related mortality of extremely low gestational age newborns after the introduction of colonization screening for multi-drug resistant organisms. Antimicrob Resist Infect Control 2020; 9:144. [PMID: 32843080 PMCID: PMC7449086 DOI: 10.1186/s13756-020-00804-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/12/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In 2013 German infection surveillance guidelines recommended weekly colonization screening for multidrug-resistant (MDRO) or highly epidemic organisms for neonatal intensive care units (NICUs) and extended hygiene measures based on screening results. It remains a matter of debate whether screening is worth the effort. We therefore aimed to evaluate sepsis related outcomes before and after the guideline update. METHODS The German Neonatal Network (GNN) is a prospective cohort study including data from extremely preterm infants between 22 + 0 and 28 + 6 gestational weeks born in 62 German level III NICUs. RESULTS Infants treated after guideline update (n = 8.903) had a lower mortality (12.5% vs. 13.8%, p = 0.036), reduced rates for clinical sepsis (31.4 vs. 42.8%, p < 0.001) and culture-proven sepsis (14.4% vs. 16.5%, p = 0.003) as compared to infants treated before update (n = 3.920). In a multivariate logistic regression analysis, nine pathogens of culture-proven sepsis were associated with sepsis-related death, e.g. Pseudomonas aeruginosa [OR 59 (19-180), p < 0.001)]. However, the guideline update had no significant effect on pathogen-specific case fatality, total sepsis-related mortality and culture-proven sepsis rates with MDRO. While the exposure of GNN infants to cefotaxime declined over time (31.1 vs. 40.1%, p < 0.001), the treatment rate with meropenem was increased (31.6 vs. 26.3%, p < 0.001). CONCLUSIONS The introduction of weekly screening and extended hygiene measures is associated with reduced sepsis rates, but has no effects on sepsis-related mortality and sepsis with screening-relevant pathogens. The high exposure rate to meropenem should be a target of antibiotic stewardship programs.
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Affiliation(s)
- Christoph Härtel
- Department of Pediatrics, University of Lübeck, Lübeck, Germany. .,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Lübeck, Germany. .,German Neonatal Network (GNN), Lübeck, Germany. .,Priming Immunity at the beginning of life (PRIMAL) Consortium, Lübeck, Germany. .,Department of Pediatrics, University of Würzburg, Josef-Schneider-Strasse 2, D-97080, Würzburg, Germany.
| | - Kirstin Faust
- Department of Pediatrics, University of Lübeck, Lübeck, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Lübeck, Germany
| | - Ingmar Fortmann
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Alexander Humberg
- Department of Pediatrics, University of Lübeck, Lübeck, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Lübeck, Germany
| | - Julia Pagel
- Department of Pediatrics, University of Lübeck, Lübeck, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Lübeck, Germany
| | - Clara Haug
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Reinhard Kühl
- German Neonatal Network (GNN), Lübeck, Germany.,Department of Pediatrics, Diakonissenkrankenhaus, Flensburg, Germany
| | - Bettina Bohnhorst
- German Neonatal Network (GNN), Lübeck, Germany.,Department of Neonatology, Hannover Medical School, Hannover, Germany
| | - Sabine Pirr
- Priming Immunity at the beginning of life (PRIMAL) Consortium, Lübeck, Germany.,Department of Neonatology, Hannover Medical School, Hannover, Germany
| | - Dorothee Viemann
- Priming Immunity at the beginning of life (PRIMAL) Consortium, Lübeck, Germany.,Department of Neonatology, Hannover Medical School, Hannover, Germany
| | - Arne Simon
- German Neonatal Network (GNN), Lübeck, Germany.,Department of Pediatrics, Saar University Homburg, Homburg, Germany
| | - Michael Zemlin
- German Neonatal Network (GNN), Lübeck, Germany.,Priming Immunity at the beginning of life (PRIMAL) Consortium, Lübeck, Germany.,Department of Pediatrics, Saar University Homburg, Homburg, Germany
| | - Silvia Poralla
- German Neonatal Network (GNN), Lübeck, Germany.,Department of Pediatrics, University of Bonn, Bonn, Germany
| | - Andreas Müller
- German Neonatal Network (GNN), Lübeck, Germany.,Department of Pediatrics, University of Bonn, Bonn, Germany
| | | | - Christian Gille
- German Neonatal Network (GNN), Lübeck, Germany.,Priming Immunity at the beginning of life (PRIMAL) Consortium, Lübeck, Germany.,Department of Neonatology, Tuebingen University Children's Hospital, Tuebingen, Germany
| | - Matthias Heckmann
- German Neonatal Network (GNN), Lübeck, Germany.,Department of Neonatology and Pediatric Intensive Care, University of Greifswald, Greifswald, Germany
| | - Jan Rupp
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Lübeck, Germany.,Department of Infectious Diseases and Medical Microbiology, University of Lübeck, Lübeck, Germany
| | - Egbert Herting
- Department of Pediatrics, University of Lübeck, Lübeck, Germany.,German Neonatal Network (GNN), Lübeck, Germany.,Priming Immunity at the beginning of life (PRIMAL) Consortium, Lübeck, Germany
| | - Wolfgang Göpel
- Department of Pediatrics, University of Lübeck, Lübeck, Germany.,German Neonatal Network (GNN), Lübeck, Germany.,Priming Immunity at the beginning of life (PRIMAL) Consortium, Lübeck, Germany
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5
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Zemlin M, Stutz R. Real-life clinical studies are needed after a quality improvement study in neonatal sepsis showed unexpected improvements. Acta Paediatr 2020; 109:1084-1085. [PMID: 32337753 DOI: 10.1111/apa.15272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Michael Zemlin
- Faculty of Medicine, General Pediatrics and Neonatology, Saarland University Medical Center and Saarland University Homburg, Homburg, Germany
| | - Regine Stutz
- Faculty of Medicine, General Pediatrics and Neonatology, Saarland University Medical Center and Saarland University Homburg, Homburg, Germany
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6
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Schöndorf D, Simon A, Wagenpfeil G, Gärtner B, Geipel M, Zemlin M, Schöndorf M, Meyer S. Colonization Screening Targeting Multidrug-Resistant Gram-Negative Pathogens Does Not Increase the Use of Carbapenems in Very Low Birth Weight Infants. Front Pediatr 2020; 8:427. [PMID: 32850541 PMCID: PMC7423965 DOI: 10.3389/fped.2020.00427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/19/2020] [Indexed: 01/17/2023] Open
Abstract
Since 2012, a colonization screening (CoS) for multidrug-resistant Gram-negative bacteria (MRGN) in very low birth weight infants (VLWBI) was implemented in order to provide a basis for an effective empiric therapy of subsequent nosocomial infections (NI). According to antibiotic stewardship, carbapenems should be reserved for NI caused by MRGN or severe NI. We examined whether the CoS increased the first-line use of carbapenems. In this retrospective cohort analysis, we enrolled all VLBWI before (2009-2011) and after (2012-2014) the introduction of CoS (2012) at a tertiary university neonatal intensive care and neonatal intermediate care unit (NIMC) in Germany. Rectal swabs were used to detect MRGN colonization (on admission and weekly until discharge from the NIMC). The use of carbapenems was measured by days of therapy (DoT). To exclude the replacement of carbapenems by other antibiotics, antibiotic therapy for late-onset sepsis (LOS) was assessed by DoT and length of therapy (LoT). In 55/201 (27.4%) VLBWI, CoS detected MRGN colonization. Compared to the cohort prior to the introduction of CoS (n = 191), a significant decrease in LoT (p < 0.001) and total DoT (p < 0.001) was seen (n = 201). This was due to a significant decrease in LoT (p < 0.001) and total DoT (p < 0.001) in the birth weight category of 1,000-1,499 g. In these infants, DoT for carbapenems (p = 0.009) was significantly lower, possibly caused by a significant decline of LOS (25 episodes vs. 39 episodes, p = 0.025). Conversely, no significant differences in LoT and total DoT were seen in infants with a birth weight <500 g (p = 1.000; p = 0.758) and in infants weighing 500-999 g (p = 0.754; p = 0.794). DoT for carbapenems was not significantly different in the total cohort after the introduction of CoS (p = 0.341). Prolonged exposure to carbapenems (in terms of DoT) significantly postponed the first detection of MRGN colonization (p = 0.023). The introduction of CoS did not result in an increased use of carbapenems. Concomitant carbapenem treatment may reduce the sensitivity of CoS relying on rectal swabs.
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Affiliation(s)
- Dominik Schöndorf
- General Pediatrics and Neonatology, University Hospital of Saarland, Homburg, Germany
| | - Arne Simon
- Pediatric Oncology and Hematology, University Hospital of Saarland, Homburg, Germany
| | - Gudrun Wagenpfeil
- Theoretical Medicine, Institute for Medical Biometrics, Epidemiology and Medical Computer Sciences, University Hospital of Saarland, Homburg, Germany
| | - Barbara Gärtner
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, University Hospital of Saarland, Homburg, Germany
| | - Martina Geipel
- General Pediatrics and Neonatology, University Hospital of Saarland, Homburg, Germany
| | - Michael Zemlin
- General Pediatrics and Neonatology, University Hospital of Saarland, Homburg, Germany
| | - Marika Schöndorf
- Pediatric Oncology and Hematology, University Hospital of Saarland, Homburg, Germany
| | - Sascha Meyer
- General Pediatrics and Neonatology, University Hospital of Saarland, Homburg, Germany
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7
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Identification and Containment of a Cluster of Two Bacillus cereus Infections in a Neonatal Intensive Care Unit. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2019; 2019:1506583. [PMID: 30805067 PMCID: PMC6360598 DOI: 10.1155/2019/1506583] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/02/2019] [Indexed: 11/18/2022]
Abstract
We report a cluster of invasive Bacillus cereus infections in a neonatal intensive care unit. We describe the clinical course of two infected patients, one of whom died of severe pneumonia after successfully being weaned from ECMO. Environmental analyses failed to yield a common source. Molecular characterization confirmed the homogeneity of both isolates. Rigorous hygiene control and adequate therapy enabled the containment of the cluster.
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Effectiveness of healthcare worker screening in hospital outbreaks with gram-negative pathogens: a systematic review. Antimicrob Resist Infect Control 2018; 7:36. [PMID: 29556377 PMCID: PMC5845297 DOI: 10.1186/s13756-018-0330-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/25/2018] [Indexed: 01/26/2023] Open
Abstract
Background Identifying the source of an outbreak is the most crucial aspect of any outbreak investigation. In this review, we address the frequently discussed question of whether (rectal) screening of health care workers (HCWs) should be carried out when dealing with outbreaks caused by gram negative bacteria (GNB). A systematic search of the medical literature was performed, including the Worldwide Outbreak Database and PubMed. Outbreaks got included if a HCW was the source of the outbreak and the causative pathogen was an Escherichia coli, Klebsiella spp., Enterobacter spp., Serratia spp., Pseudomonas aeruginosa, or Acinetobacter baumannii. This was true for 25 articles in which there were 1196 (2.1%) outbreaks due to GNB, thereof 14 HCWs who were permanently colonized by the outbreak strain. Rectal screening of HCWs was helpful in only 2 of the 1196 (0.2%) outbreaks. Instead, the hands of HCWs served as a reservoir for the outbreak strain in at least 7 articles – especially when they suffered from onychomycosis or used artificial fingernails or rings. Conclusion Due to very weak evidence, we do not recommend rectal screening of HCWs in an outbreak situation with GNB. However, besides a critical review of hand hygiene habits, it might be useful to examine the hands of staff carefully. This measure is cheap, quick to perform, and seems to be quite effective. Electronic supplementary material The online version of this article (10.1186/s13756-018-0330-4) contains supplementary material, which is available to authorized users.
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9
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Tröger B, Härtel C, Buer J, Dördelmann M, Felderhoff-Müser U, Höhn T, Hepping N, Hillebrand G, Kribs A, Marissen J, Olbertz D, Rath PM, Schmidtke S, Siegel J, Herting E, Göpel W, Steinmann J, Stein A. Clinical Relevance of Pathogens Detected by Multiplex PCR in Blood of Very-Low-Birth Weight Infants with Suspected Sepsis - Multicentre Study of the German Neonatal Network. PLoS One 2016; 11:e0159821. [PMID: 27472282 PMCID: PMC4966931 DOI: 10.1371/journal.pone.0159821] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 07/09/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction In the German Neonatal Network (GNN) 10% of very-low-birth weight infants (VLBWI) suffer from blood-culture confirmed sepsis, while 30% of VLBWI develop clinical sepsis. Diagnosis of sepsis is a difficult task leading to potential over-treatment with antibiotics. This study aims to investigate whether the results of blood multiplex-PCR (SeptiFast®) for common sepsis pathogens are relevant for clinical decision making when sepsis is suspected in VLBWI. Methods We performed a prospective, multi-centre study within the GNN including 133 VLBWI with 214 episodes of suspected late onset sepsis (LOS). In patients with suspected sepsis a multiplex-PCR (LightCycler SeptiFast MGRADE-test®) was performed from 100 μl EDTA blood in addition to center-specific laboratory biomarkers. The attending neonatologist documented whether the PCR-result, which was available after 24 to 48 hrs, had an impact on the choice of antibiotic drugs and duration of therapy. Results PCR was positive in 110/214 episodes (51%) and blood culture (BC) was positive in 55 episodes (26%). Both methods yielded predominantly coagulase-negative staphylococci (CoNS) followed by Escherichia coli and Staphylococcus aureus. In 214 BC—PCR paired samples concordant results were documented in 126 episodes (59%; n = 32 were concordant pathogen positive results, n = 94 were negative in both methods). In 65 episodes (30%) we found positive PCR results but negative BCs, with CoNS being identified in 43 (66%) of these samples. Multiplex-PCR results influenced clinical decision making in 30% of episodes, specifically in 18% for the choice of antimicrobial therapy and in 22% for the duration of antimicrobial therapy. Conclusions Multiplex-PCR results had a moderate impact on clinical management in about one third of LOS-episodes. The main advantage of multiplex-PCR was the rapid detection of pathogens from micro-volume blood samples. In VLBWI limitations include risk of contamination, lack of resistance testing and high costs. The high rate of positive PCR results in episodes of negative BC might lead to overtreatment of infants which is associated with risk of mortality, antibiotic resistance, fungal sepsis and NEC.
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Affiliation(s)
- Birte Tröger
- Department of Pediatrics at the University of Lübeck, Lübeck, Germany
- * E-mail:
| | - Christoph Härtel
- Department of Pediatrics at the University of Lübeck, Lübeck, Germany
| | - Jan Buer
- Institute of Medical Microbiology, University of Duisburg-Essen, Essen, Germany
| | - Michael Dördelmann
- Department of Pediatrics at Diakonissen Hospital Flensburg, Flensburg, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Thomas Höhn
- Department of Pediatrics at the University of Düsseldorf, Düsseldorf, Germany
| | - Nico Hepping
- Department of Pediatrics at St. Marien Hospital Bonn, Bonn, Germany
| | - Georg Hillebrand
- Department of Pediatrics at Hospital of Itzehoe, Itzehoe, Germany
| | - Angela Kribs
- Department of Pediatrics at the University of Cologne, Cologne, Germany
| | - Janina Marissen
- Department of Pediatrics at the University of Lübeck, Lübeck, Germany
| | - Dirk Olbertz
- Neonatology Unit at Südstadt Hospital Rostock, Rostock, Germany
| | - Peter-Michael Rath
- Institute of Medical Microbiology, University of Duisburg-Essen, Essen, Germany
| | - Susanne Schmidtke
- Neonatology Unit at Asclepios Hospital Hamburg-Barmbek, Hamburg, Germany
| | - Jens Siegel
- Neonatology Unit at the Children´s Hospital Hannover Auf der Bult, Hannover, Germany
| | - Egbert Herting
- Department of Pediatrics at the University of Lübeck, Lübeck, Germany
| | - Wolfgang Göpel
- Department of Pediatrics at the University of Lübeck, Lübeck, Germany
| | - Joerg Steinmann
- Institute of Medical Microbiology, University of Duisburg-Essen, Essen, Germany
| | - Anja Stein
- Department of Pediatrics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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