Antibiotic Discontinuation 24 h After Neonatal Late-Onset Sepsis Work-Up-A Validated Decision Tree Model

被引:3
作者
Goldberg, Ori [1 ,2 ,3 ]
Sokolover, Nir [1 ,2 ]
Bromiker, Ruben [1 ,2 ]
Amitai, Nofar [2 ,4 ]
Chodick, Gabriel [2 ,5 ]
Scheuerman, Oded [2 ,6 ]
Ben-Zvi, Haim [2 ,7 ]
Klinger, Gil [1 ,2 ]
机构
[1] Schneider Childrens Med Ctr Israel, Neonatal Intens Care Unit, Petah Tiqwa, Israel
[2] Tel Aviv Univ, Sackler Sch Med, Tel Aviv, Israel
[3] Hosp Sick Children, Div Resp Med, Toronto, ON, Canada
[4] Schneider Childrens Med Ctr Israel, Dept Pediat B, Petah Tiqwa, Israel
[5] Maccabi Hlth Care Serv, Maccabi Inst Hlth Serv Res, Tel Aviv, Israel
[6] Schneider Childrens Med Ctr Israel, Infect Dis Unit, Petah Tiqwa, Israel
[7] Rabin Med Ctr, Microbiol Lab, Petah Tiqwa, Israel
关键词
late-onset sepsis; neonate; antibiotic discontinuation; neutrophil-to-lymphocyte ratio; C-reactive protein; decision tree (CHAID); PREDICTION MODEL; DIAGNOSIS; RISK;
D O I
10.3389/fped.2021.693882
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objectives: Neonatal late-onset sepsis work-up is a frequent occurrence in every neonatal department. Blood cultures are the diagnostic gold standard, however, a negative culture prior to 48-72 h is often considered insufficient to exclude sepsis. We aimed to develop a decision tree which would enable exclusion of late-onset sepsis within 24 h using clinical and laboratory variables. Study Design: Infants evaluated for late-onset sepsis during the years 2016-2019, without major malformations, in a tertiary neonatal center were eligible for inclusion. Blood cultures and clinical and laboratory data were extracted at 0 and 24 h after sepsis work-up. Infants with bacteriologically confirmed late-onset sepsis were compared to matched control infants. Univariate logistic regression identified potential risk factors. A decision tree based on Chi-square automatic interaction detection methodology was developed and validated. Results: The study cohort was divided to a development cohort (105 patients) and a validation cohort (60 patients). At 24 h after initial evaluation, the best variables to identify sepsis were C-reactive protein > 0.75 mg/dl, neutrophil-to-lymphocyte ratio > 1.5 and sick-appearance at 24 h. Use of these 3 variables together with blood culture status at 24 h, enabled identification of all infants that eventually developed sepsis through the decision tree model. Our decision tree has an area under the receiver operating characteristic curve of 0.94 (95% CI: 0.90-0.98). Conclusions: In non-sick appearing infants with a negative blood culture at 24 h and normal laboratory values, sepsis is highly unlikely and discontinuing antibiotics after 24 h is a viable option.
引用
收藏
页数:7
相关论文
共 31 条
[1]  
Abdelhamid SM, 2017, J GLOB INFECT DIS, V9, P102, DOI 10.4103/jgid.jgid_1_17
[2]   C-reactive protein for late-onset sepsis diagnosis in very low birth weight infants [J].
Beltempo, Marc ;
Viel-Theriault, Isabelle ;
Thibeault, Roseline ;
Julien, Anne-Sophie ;
Piedboeuf, Bruno .
BMC PEDIATRICS, 2018, 18
[3]   C-reactive protein for diagnosing late-onset infection in newborn infants [J].
Brown, Jennifer Valeska Elli ;
Meader, Nicholas ;
Cleminson, Jemma ;
McGuire, William .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2019, (01)
[4]   Reference Ranges for Lymphocyte Counts of Neonates: Associations Between Abnormal Counts and Outcomes [J].
Christensen, Robert D. ;
Baer, Vickie L. ;
Gordon, Philip V. ;
Henry, Erick ;
Whitaker, Cody ;
Andres, Robert L. ;
Bennett, Sterling T. .
PEDIATRICS, 2012, 129 (05) :E1165-E1172
[5]  
Collins GS, 2015, ANN INTERN MED, V162, P55, DOI [10.1038/bjc.2014.639, 10.7326/M14-0697, 10.1002/bjs.9736, 10.1016/j.jclinepi.2014.11.010, 10.1186/s12916-014-0241-z, 10.1111/eci.12376, 10.1136/bmj.g7594, 10.7326/M14-0698, 10.1016/j.eururo.2014.11.025]
[6]   Sepsis-induced immune dysfunction: can immune therapies reduce mortality? [J].
Delano, Matthew J. ;
Ward, Peter A. .
JOURNAL OF CLINICAL INVESTIGATION, 2016, 126 (01) :23-31
[7]   Late-onset neonatal sepsis: recent developments [J].
Dong, Ying ;
Speer, Christian P. .
ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, 2015, 100 (03) :F257-F263
[8]   Minimum Duration of Antibiotic Treatment Based on Blood Culture in Rule Out Neonatal Sepsis [J].
Durrani, Naveed Ur Rehman ;
Rochow, Niels ;
Alghamdi, Jameel ;
Pelc, Anna ;
Fusch, Christoph ;
Dutta, Sourabh .
PEDIATRIC INFECTIOUS DISEASE JOURNAL, 2019, 38 (05) :528-532
[9]   Stratification of Risk of Early-Onset Sepsis in Newborns ≥ 34 Weeks' Gestation [J].
Escobar, Gabriel J. ;
Puopolo, Karen M. ;
Wi, Soora ;
Turk, Benjamin J. ;
Kuzniewicz, Michael W. ;
Walsh, Eileen M. ;
Newman, Thomas B. ;
Zupancic, John ;
Lieberman, Ellice ;
Draper, David .
PEDIATRICS, 2014, 133 (01) :30-36
[10]   Rapid detection of microorganisms in blood cultures of newborn infants utilizing an automated blood culture system [J].
Garcia-Prats, JA ;
Cooper, TR ;
Schneider, VF ;
Stager, CE ;
Hansen, TN .
PEDIATRICS, 2000, 105 (03) :523-527