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Minimum Duration of Antibiotic Treatment Based on Blood Culture in Rule Out Neonatal Sepsis

Ur Rehman Durrani, Naveed, MD, FCPS, MRCP*; Rochow, Niels, MD*; Alghamdi, Jameel, MD; Pelc, Anna, MSc*; Fusch, Christoph, MD, PhD; Dutta, Sourabh, MD, PhD§

The Pediatric Infectious Disease Journal: May 2019 - Volume 38 - Issue 5 - p 528–532
doi: 10.1097/INF.0000000000002182
Maternal-Neonatal Reports

Background: Neonatologists usually wait 48 hours for blood culture results before deciding to discontinue antibiotics. The objective of the study was to analyze time to positive blood culture in rule out sepsis and estimate the minimum duration of antibiotics.

Methods: Retrospective analysis of blood culture at the Neonatal Intensive Care Unit, McMaster Children’s Hospital (January 2004 to December 2013) using BacT/Alert® 3D microbial system was conducted. We calculated average time taken for blood culture samples to emit a positive signal and compared it between Gram-positive and Gram-negative organisms. Kaplan-Meier curves for time to detect positive culture were generated. A Cox proportional hazard regression model with the outcome variable “time to detect positive blood culture” and predictor variables “early-onset sepsis (EOS) versus late-onset sepsis (LOS)”, “Gram-positive versus Gram-negative” and “definite versus possible pathogen versus contaminant” was generated.

Results: Of 7,480 blood cultures performed in 9,254 neonates, 885 samples grew microorganisms. 845 culture reports from 627 neonates were analyzed. Definite or opportunistic pathogens caused 815 (96%) infections (54 EOS and 791 LOS) and the rest were contaminants. Gram-negative organisms grew significantly faster than Gram-positive (P < 0.001). Cultures from EOS were positive significantly earlier than LOS (P = 0.032). Gram-negative status was an independent predictor of early detection of a positive culture (hazard ratio 3.5 [95% CI, 2.7–4.5] P < 0.001).

Conclusion: The probability of positive blood culture beyond 24 hours for a Gram-negative organism is small. Empiric antimicrobial treatment can be reduced after 24 hours to target only Gram-positive organisms in LOS and can be stopped in EOS unless clinical or laboratory parameters strongly suggest sepsis.

From the *Department of Pediatrics, Neonatal Division, McMaster University, Hamilton Health Sciences and McMaster Children Hospital, Hamilton, Canada

Department of Pediatrics, Al-Baha University, Saudi Arabia

Department of Pediatrics, Paracelsus Medical School, General Hospital of Nuremberg, Germany

§Department of Pediatrics, Postgraduate Institute of Medical Education and Research,, Chandigarh, India.

Accepted for publication August 3, 2018.

The authors have no funding or conflicts of interest to disclose.

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Address for correspondence: Naveed Durrani, MD, FCPS, MRCP, Neonatal ICU, McMaster Children Hospital, 1280 Main Street West, Hamilton L8S4K1, Canada. E-mail:

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