Sepsis related mortality of extremely low gestational age newborns after the introduction of colonization screening for multi-drug resistant organisms
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Sepsis related mortality of extremely low gestational age newborns after the introduction of colonization screening for multi-drug resistant organisms. / 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.
In: ANTIMICROB RESIST IN, Vol. 9, No. 1, 26.08.2020, p. 144.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Sepsis related mortality of extremely low gestational age newborns after the introduction of colonization screening for multi-drug resistant organisms
AU - Härtel, Christoph
AU - Faust, Kirstin
AU - Fortmann, Ingmar
AU - Humberg, Alexander
AU - Pagel, Julia
AU - Haug, Clara
AU - Kühl, Reinhard
AU - Bohnhorst, Bettina
AU - Pirr, Sabine
AU - Viemann, Dorothee
AU - Simon, Arne
AU - Zemlin, Michael
AU - Poralla, Silvia
AU - Müller, Andreas
AU - Köstlin-Gille, Natascha
AU - Gille, Christian
AU - Heckmann, Matthias
AU - Rupp, Jan
AU - Herting, Egbert
AU - Göpel, Wolfgang
PY - 2020/8/26
Y1 - 2020/8/26
N2 - 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.
AB - 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.
KW - Anti-Bacterial Agents/therapeutic use
KW - Antimicrobial Stewardship
KW - Cefotaxime/therapeutic use
KW - Female
KW - Germany
KW - Humans
KW - Hygiene/standards
KW - Infant, Extremely Premature
KW - Infant, Newborn
KW - Intensive Care Units, Neonatal
KW - Logistic Models
KW - Male
KW - Meropenem/therapeutic use
KW - Mortality/trends
KW - Multivariate Analysis
KW - Population Surveillance
KW - Practice Guidelines as Topic/standards
KW - Prospective Studies
KW - Pseudomonas aeruginosa/isolation & purification
KW - Sepsis/drug therapy
U2 - 10.1186/s13756-020-00804-8
DO - 10.1186/s13756-020-00804-8
M3 - SCORING: Journal article
C2 - 32843080
VL - 9
SP - 144
JO - ANTIMICROB RESIST IN
JF - ANTIMICROB RESIST IN
SN - 2047-2994
IS - 1
ER -
