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.

Details

Title
Sepsis related mortality of extremely low gestational age newborns after the introduction of colonization screening for multi-drug resistant organisms
Author
Härtel, Christoph; Faust, Kirstin  VIAFID ORCID Logo  ; Fortmann, Ingmar; Humberg, Alexander; Pagel, Julia; Haug, Clara; Kühl, Reinhard; Bohnhorst, Bettina; Pirr, Sabine; Viemann, Dorothee; Simon, Arne; Zemlin, Michael; Poralla, Silvia; Müller, Andreas; Köstlin-Gille, Natascha; Gille, Christian; Heckmann, Matthias; Rupp, Jan; Herting, Egbert; Göpel, Wolfgang
Pages
1-9
Section
Research
Publication year
2020
Publication date
2020
Publisher
BioMed Central
e-ISSN
20472994
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2444088071
Copyright
© 2020. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.