Current management of late onset neonatal bacterial sepsis in five European countries

Irja Lutsar, Corine Chazallon, Francesca Ippolita Calò Carducci, Ursula Trafojer, Ben Abdelkader, Vincent Meiffredy De Cabre, Susanna Esposito, Carlo Giaquinto, Paul T. Heath, Mari Liis Ilmoja, Aspasia Katragkou, Carine Lascoux, Tuuli Metsvaht, George Mitsiakos, Emmanuelle Netzer, Lorenza Pugni, Emmanuel Roilides, Yacine Saidi, Kosmas Sarafidis, Mike SharlandVytautas Usonis, Jean Pierre Aboulker

Research output: Contribution to journalArticle

Abstract

Late onset neonatal sepsis (LOS) has a high mortality and the optimal management is poorly defined. We aimed to evaluate new expert panel-derived criteria to define LOS and characterize the current management and antibiotic susceptibility of LOS-causing organisms in Europe. A prospective observational study enrolled infants aged 4 to 90 days in five European countries. Clinical and laboratory findings as well as empiric treatment were recorded and patients were followed until the end of antibiotic therapy. Failure was defined as a change of primary antibiotic, no resolution of clinical signs, appearance of new signs/pathogens or death. Antibiotic therapy was considered appropriate if the organism was susceptible to at least one empiric antibiotic. 113 infants (median age 14 days, 62 % ≤1500 g) were recruited; 61 % were culture proven cases (28 CoNS, 24 Enterobacteriaceae, 11 other Gram-positives and 6 Gram-negative non-fermentative organisms). The predictive value of the expert-panel criteria to identify patients with a culture proven LOS was 61 % (95 % CI 52 % to 70 %). Around one third of Enterobacteriaceae were resistant to ampicillin + or cefotaxime + gentamicin but only 10 % to meropenem. Empiric treatment contained a total of 43 different antibiotic regimens. All-cause mortality was 8 % with an additional 45 % classified as failure of empiric therapy, mainly due to change of primary antibiotics (42/60). Conclusions: The expert panel - derived diagnostic criteria performed well identifying a high rate of culture proven sepsis. Current management of LOS in Europe is extremely variable suggesting an urgent need of evidence-based guidelines.

Original languageEnglish
Pages (from-to)997-1004
Number of pages8
JournalEuropean Journal of Pediatrics
Volume173
Issue number8
DOIs
Publication statusPublished - 2014

Keywords

  • Antibiotic resistance
  • Meropenem
  • Neonatal meningitis
  • Observational study

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

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    Lutsar, I., Chazallon, C., Carducci, F. I. C., Trafojer, U., Abdelkader, B., De Cabre, V. M., Esposito, S., Giaquinto, C., Heath, P. T., Ilmoja, M. L., Katragkou, A., Lascoux, C., Metsvaht, T., Mitsiakos, G., Netzer, E., Pugni, L., Roilides, E., Saidi, Y., Sarafidis, K., ... Aboulker, J. P. (2014). Current management of late onset neonatal bacterial sepsis in five European countries. European Journal of Pediatrics, 173(8), 997-1004. https://doi.org/10.1007/s00431-014-2279-5