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795 Diagnosis of Late Onset Sepsis in the Neonatal Intensive Care Unit (NICU) Population

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Patricia DeLaMora, MD , Weill Cornell Medical Center, New York, NY
Sameer J. Patel, MD , Columbia University Medical Center, New York, NY
Luis Alba , Columbia University Medical Center, New York, NY
Christina Gagliardo , Weill Cornell Medical Center, New York, NY
Jeffrey Perlman , Weill Cornell Medical Center, New York, NY
Theoklis Zaoutis, MD , Children's Hospital of Philadelphia, Philadelphia, PA
Priya Prasad, MPH , Children's Hospital of Philadelphia, Philadelphia, PA
David Paul, MD , Christiana Care Health System, Newark, DE
Lisa Saiman , Columbia University Medical Center, New York, NY

Background: Accurate diagnosis of late onset sepsis and central line-associated bloodstream infections (CLABSIs) in the NICU population can be facilitated by obtaining 2 blood cultures. However, difficulties obtaining blood cultures or concerns about blood volume may limit this practice.

Objective: To determine the potential impact of obtaining 2 blood cultures for evaluation of late onset sepsis prior to initiation of antibiotics on the duration of treatment.

Methods: As part of a larger prospective study of antimicrobial stewardship for eligible infants ≥ 4 days of age hospitalized in 4 level III NICUs, we determined the proportion of infants who had 0, 1, and 2 blood cultures obtained for evaluation of late onset sepsis and compared the duration of antibiotic treatment among these groups.

Results: From May – October 2009, 1098 infants (mean birth weight 2404 grams) were enrolled of whom 96 (8.7%) weighed < 1000 g and 463 (42.1%) weighed > 2500 g at birth.  Overall, 152 (14%) infants had 200 evaluations for late onset sepsis as shown in the Table.  When 2 blood cultures were obtained, 14 of 18 (78%) evaluations included central line (CL) and peripheral blood cultures. Of the 18 evaluations where two cultures were obtained, none had both cultures positive, 13 (72%) were both negative, and 5 (28%) had one culture positive.  When 1 blood culture was obtained, 51 (35%), 45 (31%), and 50 (34%) were peripheral, CL, or blood cultures from an unknown site, respectively. When a single positive blood culture was obtained, 79% (19/24) were positive for coagulase negative staphylococci. There was a trend towards an increased duration of therapy when no cultures were obtained (7.5 days) compared with 2 negative blood cultures (3.5 days) (p = 0.14).

Conclusions: In this pilot study, most infants were not evaluated for late onset sepsis with 2 blood cultures.  Obtaining 2 cultures prior to initiation of therapy for late onset sepsis could decrease antibiotic utilization in the NICU population and potentially improve the diagnosis of CLABSI.