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Comparison of 4-day and 7-day antibiotic courses for probable neonatal sepsis
S64
Abstracts
drugs. More extensive data are needed in order to assess caspofungin efficacy and safety in neonates and to create a specific neonatal schedule. doi:10.1016/j.earlhumdev.2008.09.162
Abstract UENPS.147 Comparison of 4-day and 7-day antibiotic courses for probable neonatal sepsis Saini Shiv Sajan⁎, Dutta Sourabh, Ray Pallab, Narang Anil Postgraduate Institute of Medical Education and Research, Chandigarh, India Background and aim There are no evidence-based guidelines of antibiotic duration for probable neonatal sepsis, although a 7-day course is commonly administered in clinical practice. We hypothesized that a 4-day antibiotic course is not inferior to a 7-day course, amongst neonates, >30 weeks and >1 kg at birth, with probable sepsis, whose clinical signs remit within 96 h and blood culture is sterile.
Materials and methods On line registry was implemented. All newborns admitted to a NICU were enrolled during all admission time. Fields include birth, admission and discharge dates, birth weight and gestational age, days in intensive care, ventilation days, type and days of central venous catheters (CVC), sepsis, pneumonia, meningitis, necrotizing enterocolitis (NEC), isolates, resistance and antibiotics used. The registry started on January 1st, 2008; 23 NICU were enrolled. Results A great variability amongst Units was found concerning days in intensive care, invasive ventilation, CVC use, admitted very low birth weight infants (VLBW) and adherence to the project. On July 20th, 2167 patients had been introduced, accounting for 27,889 admission days, 15% of VLBW, 352 ventilated (ventilation days 3151); 601 infants had had CVC (CVC days 7396). There were 183 episodes of infection in 150 infected newborns; 7% of admitted patients had at least one episode of infection; the rate of episodes of infection was 6.6/1000 admission days, but it climbs to 11/1000 in VLBW infants; there were 166 episodes of sepsis, 19 pneumonia, 1 meningitis and 17 NEC. The rate of associated CVC blood-stream infection was 19/1000 CVC days and that of tracheal tube (TT) associated pneumonia 5/1000TT days. The most common isolate was coagulase negative Staphylococcus. Of the infected newborns 2.7% died because of infection.
Materials and methods Conclusions This was a randomized, controlled, open-labeled trial with blocking and stratification by birth weight. Neonates, >30 weeks and > 1000 g, with signs of sepsis and elevated C reactive protein were enrolled, if not already on antibiotics. Randomization to 4-day or 7-day antibiotic courses was done at 96 h if the baby had remitted, blood culture was sterile and meningitis was ruled out. Subjects were followed up for 15 days after stopping antibiotics, including hospital observation for at least 48 h. The key outcome was “treatment failure” in follow-up, defined as reappearance of signs of sepsis, with or without laboratory evidence and adjudicated to be a relapse by a blinded committee.
The surveillance system provides a valuable knowledge on health-care associated infections enabling neonatologist to improve data and searching causes responsible for basal deviations. doi:10.1016/j.earlhumdev.2008.09.164
Abstract UENPS.149 Candida spp catheter-associated infection in neonatal period
Results Of 240 babies evaluated, 188 were excluded [persistent signs at 96 h: 68; blood culture positive and/or meningitis: 106, no consent: 8 and logistic reasons: 6]. 52 babies were randomized to receive 4-day (n = 26) or 7-day courses (n = 26). Baseline variables were balanced in the 2 groups. Primary outcome assessment could be done in 25 cases in either group. There was no significant difference in the treatment failure rates between the 2 groups (3 in 7-day group vs. 0 in 4-day group, p = 0.23).
Rosmanova Radosveta⁎ Rosmanova R., V. Atanasova, Hr. Hitkova⁎, V. Hristova, Pleven ~ Bulgaria Background and aim
There was no statistically significant difference in the treatment failure rate between the 4-day and 7-day antibiotic course groups among neonates >30 weeks and >1000 g, with probable sepsis without meningitis, who become asymptomatic within 4 days of intravenous antibiotics.
The fungi of Candida species are widely distributed in the environment. They are normal inhabitant of gastro-intestinal and female genital tracts. This determines the higher colonization of the newborns. Candida spp is 4th in frequency among etiologic causes of nosocomial infections. The frequency of fungal catheter-associated infection is about 8% without upward tendency and a main cause is Candida species. The frequency of candidiasis ranges from 1.2 to 5.6% in neonatal intensive cares units. Risk factors are: presence of vaginal Candida as colonization or infection of the mother; characteristics of the newborn immune system; primary broad-spectrum antibiotic therapy, parenteral nutrition and a placement of intravascular catheters.
doi:10.1016/j.earlhumdev.2008.09.163
Materials and methods
Conclusions
Abstract UENPS.148 The Portuguese prospective surveillance system on health-care associated infections in the NICU Maria Teresa Neto, on behalf of the National Programme⁎ Hospital Dona Estefânia, Lisboa, Portugal
We are presented with 7 cases of Candida spp-associated infection. 225 children with placed central venous catheter are treated in NICU of University Hospital — Pleven from 1999 to 2001. The birth weight of neonates ranges from 950 to 4050 g and the gestation age — from 31 to 40 gestation weeks. Reasons of hospitalization are severe asphyxia, birth trauma, prematurity, and seizures. Duration of catheter stay was from 4 to 14 days. Primary combined antibiotic therapy included cephalosporines 2nd generation and aminoglycozides. Results
Background and aim Health-care associated infections (HCAIs) in the Neonatal Intensive Care Unit (NICU) are fearful events with great morbidity and mortality. Prospective surveillance provides knowledge on the endemic rates, microbiology and resistance, helping neonatologists to improve quality on healthcare. The aim is to present the Portuguese surveillance system on HCAIs in NICUs.
Candida in blood culture was found in 1 case only, when there were data of generalized infection. Suspected catheter-associated endogen Candida-sepsis was in 1 newborn, which mother was with vaginal candidiasis and viral hepatitis. Clinical manifestation in other cases was skin-mucous form with colonization of the catheter tip. All children are treated by removal of the catheter and administering of systemic antifungal drugs parenteral and/or peroral — Diflucan or Ketokonazole. The outcome is good in all children.
Abstracts
drugs. More extensive data are needed in order to assess caspofungin efficacy and safety in neonates and to create a specific neonatal schedule. doi:10.1016/j.earlhumdev.2008.09.162
Abstract UENPS.147 Comparison of 4-day and 7-day antibiotic courses for probable neonatal sepsis Saini Shiv Sajan⁎, Dutta Sourabh, Ray Pallab, Narang Anil Postgraduate Institute of Medical Education and Research, Chandigarh, India Background and aim There are no evidence-based guidelines of antibiotic duration for probable neonatal sepsis, although a 7-day course is commonly administered in clinical practice. We hypothesized that a 4-day antibiotic course is not inferior to a 7-day course, amongst neonates, >30 weeks and >1 kg at birth, with probable sepsis, whose clinical signs remit within 96 h and blood culture is sterile.
Materials and methods On line registry was implemented. All newborns admitted to a NICU were enrolled during all admission time. Fields include birth, admission and discharge dates, birth weight and gestational age, days in intensive care, ventilation days, type and days of central venous catheters (CVC), sepsis, pneumonia, meningitis, necrotizing enterocolitis (NEC), isolates, resistance and antibiotics used. The registry started on January 1st, 2008; 23 NICU were enrolled. Results A great variability amongst Units was found concerning days in intensive care, invasive ventilation, CVC use, admitted very low birth weight infants (VLBW) and adherence to the project. On July 20th, 2167 patients had been introduced, accounting for 27,889 admission days, 15% of VLBW, 352 ventilated (ventilation days 3151); 601 infants had had CVC (CVC days 7396). There were 183 episodes of infection in 150 infected newborns; 7% of admitted patients had at least one episode of infection; the rate of episodes of infection was 6.6/1000 admission days, but it climbs to 11/1000 in VLBW infants; there were 166 episodes of sepsis, 19 pneumonia, 1 meningitis and 17 NEC. The rate of associated CVC blood-stream infection was 19/1000 CVC days and that of tracheal tube (TT) associated pneumonia 5/1000TT days. The most common isolate was coagulase negative Staphylococcus. Of the infected newborns 2.7% died because of infection.
Materials and methods Conclusions This was a randomized, controlled, open-labeled trial with blocking and stratification by birth weight. Neonates, >30 weeks and > 1000 g, with signs of sepsis and elevated C reactive protein were enrolled, if not already on antibiotics. Randomization to 4-day or 7-day antibiotic courses was done at 96 h if the baby had remitted, blood culture was sterile and meningitis was ruled out. Subjects were followed up for 15 days after stopping antibiotics, including hospital observation for at least 48 h. The key outcome was “treatment failure” in follow-up, defined as reappearance of signs of sepsis, with or without laboratory evidence and adjudicated to be a relapse by a blinded committee.
The surveillance system provides a valuable knowledge on health-care associated infections enabling neonatologist to improve data and searching causes responsible for basal deviations. doi:10.1016/j.earlhumdev.2008.09.164
Abstract UENPS.149 Candida spp catheter-associated infection in neonatal period
Results Of 240 babies evaluated, 188 were excluded [persistent signs at 96 h: 68; blood culture positive and/or meningitis: 106, no consent: 8 and logistic reasons: 6]. 52 babies were randomized to receive 4-day (n = 26) or 7-day courses (n = 26). Baseline variables were balanced in the 2 groups. Primary outcome assessment could be done in 25 cases in either group. There was no significant difference in the treatment failure rates between the 2 groups (3 in 7-day group vs. 0 in 4-day group, p = 0.23).
Rosmanova Radosveta⁎ Rosmanova R., V. Atanasova, Hr. Hitkova⁎, V. Hristova, Pleven ~ Bulgaria Background and aim
There was no statistically significant difference in the treatment failure rate between the 4-day and 7-day antibiotic course groups among neonates >30 weeks and >1000 g, with probable sepsis without meningitis, who become asymptomatic within 4 days of intravenous antibiotics.
The fungi of Candida species are widely distributed in the environment. They are normal inhabitant of gastro-intestinal and female genital tracts. This determines the higher colonization of the newborns. Candida spp is 4th in frequency among etiologic causes of nosocomial infections. The frequency of fungal catheter-associated infection is about 8% without upward tendency and a main cause is Candida species. The frequency of candidiasis ranges from 1.2 to 5.6% in neonatal intensive cares units. Risk factors are: presence of vaginal Candida as colonization or infection of the mother; characteristics of the newborn immune system; primary broad-spectrum antibiotic therapy, parenteral nutrition and a placement of intravascular catheters.
doi:10.1016/j.earlhumdev.2008.09.163
Materials and methods
Conclusions
Abstract UENPS.148 The Portuguese prospective surveillance system on health-care associated infections in the NICU Maria Teresa Neto, on behalf of the National Programme⁎ Hospital Dona Estefânia, Lisboa, Portugal
We are presented with 7 cases of Candida spp-associated infection. 225 children with placed central venous catheter are treated in NICU of University Hospital — Pleven from 1999 to 2001. The birth weight of neonates ranges from 950 to 4050 g and the gestation age — from 31 to 40 gestation weeks. Reasons of hospitalization are severe asphyxia, birth trauma, prematurity, and seizures. Duration of catheter stay was from 4 to 14 days. Primary combined antibiotic therapy included cephalosporines 2nd generation and aminoglycozides. Results
Background and aim Health-care associated infections (HCAIs) in the Neonatal Intensive Care Unit (NICU) are fearful events with great morbidity and mortality. Prospective surveillance provides knowledge on the endemic rates, microbiology and resistance, helping neonatologists to improve quality on healthcare. The aim is to present the Portuguese surveillance system on HCAIs in NICUs.
Candida in blood culture was found in 1 case only, when there were data of generalized infection. Suspected catheter-associated endogen Candida-sepsis was in 1 newborn, which mother was with vaginal candidiasis and viral hepatitis. Clinical manifestation in other cases was skin-mucous form with colonization of the catheter tip. All children are treated by removal of the catheter and administering of systemic antifungal drugs parenteral and/or peroral — Diflucan or Ketokonazole. The outcome is good in all children.