Early stoppage of antibiotics in blood culture negative term suspected early onset sepsis and their 7 days outcome
Abstract
Introduction: Sepsis is the commonest cause of neonatal mortality; it is responsible for about 30-50% of the total neonatal deaths in developing countries. It is estimated that up to 20% of neonates develop sepsis and approximately 1% die of sepsis related causes. Despite receiving extensive care in hospitals in the form of ventilator and inotropic support in intensive care set up, 2-3% of term and 20-30% of preterm infants still die of early onset sepsis (EOS). Clinical suspicion therefore frequently leads to empirical antibiotic therapy in uninfected infants. Treating an uninfected infant for 5 to 7 days means disrupting maternal bonding and breast feeding for an extended period of time, pain and distress from starting IVs, exposing the infant to drugs with potential toxicities, fostering the development of antibiotic resistant flora, and increasing the probability that the infant will experience a more serious morbidity later in the course of hospitalization.
Material and Method: The study cohort consisted of the all term babies hospitalised with early onset sepsis to the S.C.B M.C.H and S.V.P.P.G.I.P, Cuttack from October 2016 to September 2018.
Result: Out of total 186 neonates with suspected early onset sepsis, majority were male (64%) and 93% presented within 24 hours of life. The most common perinatal risk factor noted was low birth weight (43%) followed by perinatal asphyxia (24.2%). 96.2% of the neonates were symptomatic at the time of admission; the most common symptom being respiratory distress (73.6%). The blood culture was positive in 25.8% babies. The incidence of culture positive sepsis in symptomatic babies was 27%. None of the asymptomatic babies were culture positive. Only 49% of screen positive babies were blood culture positive. Antibiotics were stopped in 133 babies and unnecessary use of antibiotics was reduced by 82.6%. No sepsis related adverse outcome was noted in 7 days following stoppage of antibiotics.
Conclusion: It is safe to stop antibiotics in term EOS babies if the 48 hour blood culture is negative and baby is asymptomatic.
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