Dear colleagues,

Could you share your practise of empirical AB choice in your NICU when you suspect late onset sepsis. I will appreciate also if you add:

1.Time definitions of LOS in your NICU.

2. Rate of LOS in VLBW group in NICU.

3. No of beds in NICU.

4. No of admissions per year.

I believe that LOS is one of biggest issues in many places were tiny babies are in care.Thank you in advance for your responses.

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Audrius

Kaunas Medical University Hospital, Lithuania

The CDC definition of LOS is > 48 hrs

We generally use Vancomycin & Piperacillin + Tazobactum

Funny but true but we hardly see any sepsis once the baby is off the ventilator

The source of LOS may be community or nosocomial. We must evaluate LOS patients according to these two cathegories. If the baby admit to hospital from community, My preference for empiric combination is cefotaxime and amikacin. But If I think that LOS is nosocomial, my preference change to status of unit profile. For My unit, The combination of Carpapenem and Vancomycine is best choice according to nosocomial infection data.

I hope this information may be useful for you.

In Copenhagen we are right now discussing our choice of antibiotics. We have a problem with ampicillin and gentamycin resistent gram negative bacteria. Our microbiologists wants to use meropenem and gentamycin for both early and late onset sepsis, but we are worried about the danger of resistent bacteria. Our choice now would be ampicillin and gentamycin for early onset and cefuroxim and gentamycin for LOS. I think that 48 hrs is the appropiate time to differ between early and late onset.

Jes Reinholdt

Staff Specialist

NICU

Rigshospitalet

Copenhagen

It is true Jes. That was your practice in Rigshospitalet, when I worked in your unit in the late 90s for 2 years. It is surprising that you experience resistant infections in your units (very low nosocomial sepsis rate). In developnig countries like Egypt we had greater problem with nosocomial sepsis, Klebseilla pneumonia is the commonest organism and about 66% of strains are ESBL producers according to a recent study we have just finnished. It is my practice to give meropenem + vancomycin whenever we encounter nosocmial sepsis pending results of C&S. This practice is exe=cellent according to our practice (Experience rather than evidence-based), we are actually in a situation where most neonatologist will not accept a RCT comparing this practice with other antibiotics. I woudl also add that the wide use of cefotaxime and other cephalosporines in our unit in the 80s and 90s was probably one factor for the development of ESBL gram negative strains. We do not expeience resistance to these antibiotic combination till now as 100% of our gram negative strains we sensitive to meropenem. I do not know what will happen in the future with the deveolpemnt of more resistant bugs.

Nice to hear from you Hesham. The problem in our unit is perhaps due to the obstetric department using Ampicillin and Metronidazol for mothers with PROM. Interesting to hear that other NICU´s are using Meropenem for empiric treatment. What is your choice for early onset sepsis??

Jes Reinholdt

Staff Specialist

NICU

Rigshospitalet

Copenhagen

We still use Amp. and Gent. for early onset sepsis