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- Title
Sepsis related mortality of extremely low gestational age newborns after the introduction of colonization screening for multi-drug resistant organisms.
- Authors
Härtel, Christoph; Faust, Kirstin; 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
- 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.
- Subjects
SEPSIS; GESTATIONAL age; PREMATURE infants; LOGISTIC regression analysis; INTENSIVE care units
- Publication
Antimicrobial Resistance & Infection Control, 2020, Vol 9, Issue 1, pN.PAG
- ISSN
2047-2994
- Publication type
Article
- DOI
10.1186/s13756-020-00804-8