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Current management of late onset neonatal bacterial sepsis in five European countries.
MedLine Citation:
PMID:  24522326     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
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 Sharland; Vytautas Usonis; Jean-Pierre Aboulker;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-2-13
Journal Detail:
Title:  European journal of pediatrics     Volume:  -     ISSN:  1432-1076     ISO Abbreviation:  Eur. J. Pediatr.     Publication Date:  2014 Feb 
Date Detail:
Created Date:  2014-2-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7603873     Medline TA:  Eur J Pediatr     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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