Sepsis related mortality of extremely low gestational age newborns after the introduction of colonization screening for multi-drug resistant organisms
Haertel C, Faust K, Fortmann I, Humberg A, Pagel J, Haug C, Kuehl R, Bohnhorst B, Pirr S, Viemann D, Simon A, Zemlin M, Poralla S, Mueller A, Koestlin-Gille N, Gille C, Heckmann M, Rupp J, Herting E, Goepel W (2020)
Publication Type: Journal article
Publication year: 2020
Journal
Book Volume: 9
Article Number: 144
Journal Issue: 1
DOI: 10.1186/s13756-020-00804-8
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.
Involved external institutions
Universität zu Lübeck
Germany (DE)
Universitätsklinikum Schleswig-Holstein (UKSH)
Germany (DE)
PRIMAL-Konsortium / PRIMAL Consortium
Germany (DE)
Eberhard Karls Universität Tübingen
Germany (DE)
Deutsches Zentrum für Infektionsforschung (DZIF)
Germany (DE)
Germany (DE)
Universitätsklinikum Schleswig-Holstein (UKSH)
Germany (DE)
PRIMAL-Konsortium / PRIMAL Consortium
Germany (DE)
Eberhard Karls Universität Tübingen
Germany (DE)
Deutsches Zentrum für Infektionsforschung (DZIF)
Germany (DE)
How to cite
APA:
Haertel, C., Faust, K., Fortmann, I., Humberg, A., Pagel, J., Haug, C.,... Goepel, W. (2020). Sepsis related mortality of extremely low gestational age newborns after the introduction of colonization screening for multi-drug resistant organisms. Antimicrobial Resistance and Infection Control , 9(1). https://dx.doi.org/10.1186/s13756-020-00804-8
MLA:
Haertel, Christoph, et al. "Sepsis related mortality of extremely low gestational age newborns after the introduction of colonization screening for multi-drug resistant organisms." Antimicrobial Resistance and Infection Control 9.1 (2020).
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