Double Blood Culture Policy Is More Effective Than Single In Neonatal Intensive Units

Abstract

Aim: Blood culture (BC) sampling and antibiotic administration are common practices in Neonatal Intensive Care Units(NICUs). However, false positive BC results might affect clinician’s decision and lead to inappropriate antibiotic treatments. The aim of this study was to investigate the effect of double culture on clinical application. Material and Methods: The study was conducted retrospectively. The blood culture results of the patients admitted to the NICU between 2016-2019 were analyzed. Considering sepsis before 2017, we took only one sample from the patient. After this period, we started to take double blood cultures. Time frames of BCs were investigated to two groups as early and late onset sepsis fistly, and then subgroups as; a-) Group 1, BCs in the first 24 hours, b-)Group 2, between 24 to 72 hours, and c-)Group 3, after 72 hours. Results: Total of 1747 BC samples were taken in study. Majority of BCs were in Group 3(62%). Male/female ratio was 1.3:1. Staphylococcus Epidermidis(S. Epi) was major source for the contamination. But, by taking dBCs, we were able to eliminate most S.Epi contamination in Group 2 (11%vs.3%) and in Group 3(41%to14%). We were able to identify some resistant Gr(-) pathogens in one arm although the other arm was negative, by taking dBC. Conclusions: Our study indicates that dBC policy in NICUs could help to clinicians for judicious decision in antibiotic use and decrease unnecessary antibiotic exposure of infants. Also it could be enable to detect some highly pathogen microorganism easily. Key words: Newborn, Septicemia, Blood culture, Coagulase Negative Staphylococci, contamination

Keywords

• Newborn
• Septicemia
• Blood culture
• Coagulase Negative Staphylococci
• contamination

Project Number

yok

Yenidoğan Yoğun Bakım Ünitesinde Çift Kan Kültürü Politikası Tekliden Daha Etkili

Abstract

Amaç: Yenidoğan Yoğun Bakım Ünitelerinde (YYBB) kan kültürü örneklemesi ve antibiyotik uygulaması yaygın uygulamalardır. Ancak yanlış pozitif kültür sonuçları klinisyenin kararını etkileyebilir ve uygun olmayan antibiyotik tedavilerine yol açabilir. Bu çalışma çift kültürün klinik uygulamaya etkisini araştırmak amacıyla yapılmıştır. Gereç ve Yöntemler: Çalışma retrospektif olarak yapıldı. 2016-2019 yılları arasında YYBÜ'ye başvuran hastaların kan kültürü sonuçları incelendi. 2017 öncesi dönemde sepsis düşünüldüğünde hastalarımızdan sadece bir örnek alıyorduk. Bu süreden sonra çift kan kültürü almaya başladık. Kan kültürleri alım zamanına göre; ilk olarak erken ve geç başlangıçlı sepsis olmak üzere iki gruba, ardından alt gruplara; a-) Grup 1, ilk 24 saatte kültür, b-)Grup 2, 24-72 saat ve c-)Grup 3, 72 saatten sonra kan kültürü alınanlar olarak gruplandırıldı. Bulgular: Çalışmada toplam 1747 kültür örneği alındı. Kan kültürlerinin çoğu Grup 3'teydi (%62). Erkek/kadın oranı 1.3:1 idi. Staphylococcus Epidermidis(S. Epi), kontaminasyon için ana etkendi. Ancak, çift kan kültürü alarak, Grup 2'deki (%11'e karşı %3) ve Grup 3'teki (%41 ila %14) çoğu S.Epi kontaminasyonunu ortadan kaldırmayı başardık. Ayrıca çift kan kültürü alarak bir kolda bazı dirençli Gr(-) patojenleri diğer kol negatif olmasına rağmen tespit edebildik. Sonuçlar: Çalışmamız, YYBB'lerde çift kan kültürü politikasının klinisyenlere antibiyotik kullanımında mantıklı karar vermelerine yardımcı olabileceğini ve bebeklerin gereksiz antibiyotik maruziyetini azaltabileceğini göstermektedir. Ayrıca bazı patojen mikroorganizmaların kolaylıkla tespit edilmesini sağlayabilir.

Keywords

• Yenidoğan
• Septisemi
• Kan kültürü
• Koagülaz Negatif Stafilokoklar
• Kontaminasyon

Supporting Institution

yok

Project Number

yok

References

1. 1. Leonard, E. and K. Dobbs, Postnatal bacterial infections. Fanaroff and Martin's Neonatal-Perinatal Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders, 2015.
2. 2. Nizet, V. and J.O. Klein, Bacterial sepsis and meningitis. Infectious diseases of the fetus and newborn, 2011. 7: p. 223-264.
3. 3. Satar, M., A.E. Arisoy, and I.H. Celik, Turkish Neonatal Society guideline on neonatal infections-diagnosis and treatment. Turk Pediatri Ars, 2018. 53(Suppl 1): p. S88-s100.
4. 4. van Herk, W., M. Stocker, and A.M. van Rossum, Recognising early onset neonatal sepsis: an essential step in appropriate antimicrobial use. J Infect, 2016. 72 Suppl: p. S77-82.
5. 5. Dong, Y. and C.P. Speer, Late-onset neonatal sepsis: recent developments. Arch Dis Child Fetal Neonatal Ed, 2015. 100(3): p. F257-63.
6. 6. Paolucci, M., M.P. Landini, and V. Sambri, How can the microbiologist help in diagnosing neonatal sepsis? Int J Pediatr, 2012. 2012: p. 120139.
7. 7. Cantey, J.B. and S.D. Baird, Ending the Culture of Culture-Negative Sepsis in the Neonatal ICU. Pediatrics, 2017. 140(4).
8. 8. Hall, K.K. and J.A. Lyman, Updated review of blood culture contamination. Clin Microbiol Rev, 2006. 19(4): p. 788-802.

9. 9. Mirrett, S., et al., Relevance of the number of positive bottles in determining clinical significance of coagulase-negative staphylococci in blood cultures. J Clin Microbiol, 2001. 39(9): p. 3279-81.
10. 10. Wayne, P., Principles and procedures for blood cultures; approved guideline, CLSI document M47-A. Clinical and Laboratory Standards Institute (CLSI), 2007.
11. 11. Wayne, P.A., Performance Standard for Antimicrobial Susceptibility Testing. Twentieth Informational Supplement, . Clinical & Laboratory Standard Institute,, 2010;30, M100-M120.
12. 12. Ting, J.Y., et al., Association between antibiotic use and neonatal mortality and morbidities in very low-birth-weight infants without culture-proven sepsis or necrotizing enterocolitis. JAMA pediatrics, 2016. 170(12): p. 1181-1187.
13. 13. Cantey, J.B., et al., Reducing unnecessary antibiotic use in the neonatal intensive care unit (SCOUT): a prospective interrupted time-series study. The Lancet Infectious Diseases, 2016. 16(10): p. 1178-1184.
14. 14. Li, J., J.J. Plorde, and L.G. Carlson, Effects of volume and periodicity on blood cultures. Journal of clinical microbiology, 1994. 32(11): p. 2829-2831.
15. 15. Tomar, P., et al., Simultaneous two-site blood culture for diagnosis of neonatal sepsis. Indian pediatrics, 2017. 54(3): p. 199-203.
16. 16. Sarkar, S., et al., A study of the role of multiple site blood cultures in the evaluation of neonatal sepsis. Journal of Perinatology, 2006. 26(1): p. 18.
17. 17. Sarkar, S., et al., Role of multiple site blood cultures to document the clearance of bacteremia in neonates. Journal of perinatology, 2007. 27(2): p. 101.
18. 18. Struthers, S., et al., A comparison of two versus one blood culture in the diagnosis and treatment of coagulase-negative staphylococcus in the neonatal intensive care unit. Journal of perinatology, 2002. 22(7): p. 547.
19. 19. Stoll, B.J., et al., Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. The Journal of pediatrics, 1996. 129(1): p. 63-71.
20. 20. Wiswell, T.E. and W.E. Hachey, Multiple site blood cultures in the initial evaluation for neonatal sepsis during the first week of life. The Pediatric infectious disease journal, 1991. 10(5): p. 365-369.
21. 21. Stark, A.R., Levels of neonatal care. Pediatrics, 2004. 114(5): p. 1341-1347.
22. 22. Ronchi, A., et al., Viral respiratory tract infections in the neonatal intensive care unit: the VIRIoN-I study. The Journal of pediatrics, 2014. 165(4): p. 690-696.