Title
Time to positivity of neonatal blood cultures : fast and furious? Time to positivity of neonatal blood cultures : fast and furious?
Author
Faculty/Department
Faculty of Medicine and Health Sciences
Publication type
article
Publication
Edinburgh ,
Subject
Human medicine
Source (journal)
Journal of medical microbiology. - Edinburgh, 1968, currens
Volume/pages
60(2011) :4 , p. 446-453
ISSN
0022-2615
ISI
000289589300006
Carrier
E
Target language
English (eng)
Full text (Publishers DOI)
Affiliation
University of Antwerp
Abstract
The aim of this study was to determine the time to positivity (TTP) of neonatal blood cultures, to investigate differences between early onset versus late-onset sepsis, and non-proven versus proven sepsis, and to examine differences in TTP by organism type using a retrospective observational study at the Neonatal Intensive Care Unit, Antwerp University Hospital, Belgium. The subjects were 1828 neonates with suspected sepsis who were treated with antimicrobials for at least 3 days. The TTP was recorded for all episodes of suspected sepsis in an approximately 6.5 year period. A total of 2916 blood cultures were collected, of which 437 (15 %) became positive. The overall TTP was 21.33 h (Q1Q3 13.1732.46). The difference between the median TTP in early onset versus late-onset sepsis was 0.83 h (22.00 versus 21.17 h, P=0.75). The median TTP for Gram-negative organisms was 11.17 h (Q1Q3 8.8415.67), whereas the median TTP for Gram-positive organisms was 23.59 h (Q1Q3 15.2934.58, P<0.001). In Gram-positive isolates, the median TTP for coagulase-negative staphylococci (CNS) was 26.67 h (Q1Q3 19.0038.17), whereas the median TTP for non-CNS was 12.83 h (Q1Q3 10.5018.17, P<0.001). The median TTP in proven sepsis was 20.17 h (Q1Q3 13.0030.37), whereas it was 29.67 h (Q1Q3 21.1750.63, P<0.001) in non-proven sepsis. TTP of neonatal blood cultures was significantly shorter for Gram-negative organisms. We suggest shortening the total incubation time of neonatal blood cultures to a maximum of 3 days. However, blood cultures collected in infants <72 h of age might require a longer incubation time. According to our results, it may be safe to narrow the antimicrobial spectrum to solely target Gram-positive bacteria when the culture is still negative after 48 h, and to cease antimicrobial therapy when the culture is still negative after 72 h in clinically well infants.
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