Paper on interpreting blood cultures

[Vicky Payne]

This might be useful to some, covers paediatrics and some neonates. 

"Waiting until 48 hours to stop antibiotic therapy in all children is an outdated approach. Research shows that 90% of bacteria will have grown by 24 hours and 95% by 36 hours. In children with low BSI suspicion, stopping antibiotics at 24–36 hours with good safety-netting advice avoids unnecessary hospitalisation without jeopardising patient safety"

https://ep.bmj.com/content/edpract/106/4/244.full.pdf

Just for fun.......anyone stopping at 24 hours?

[Stefan Johansson]

I would love to, but we mostly work per the outdated approach

[TMohns]

Dear Vicky,

we have a slightly different approach:

Our approach was (4 years ago) to stop at 48 Hours.

First step was to stop at 36 Hours what we do for all Patients in our Population (also ELGAN) if the other parameters (CRP, WBC) stay normal.

 

the Last 3 years we focused on optimalization to decrease use of antibiotics and length of stay.

1. In Term Babies with indication for antibiotic Treatment (>2 risk factors, red flag) we start treatment en check CRP + PCT two times within  24 Hours. If PCT is low we stop antibiotics at 24 Hours. Approach is based on Lancet publication over NEOPINS trial (we participated).

2. For Babies below 37 weeks we still try to implementatie same approach but until now there is less evidence so we still discuss safety 😏

3. For use in our NICU we also would like to implement PCT and other markers to optimize treatment Not only to stop earlier but to start less 🤗

It’s tricky stuff and we Hope to improve further by using “new technologies “ as smart algorithms based on vitals procent other datasets 😎

Gr. Thilo

 

 

[roserporta]

We're stopping at 36-48 hours, but trying to move for shorter period in those babies with low suspiction,  with difficulties to obtain a new iv access...  I'm firmly convinced that 24-36 hours is the best approach

[lukaswisgrill]

Might be an interesting approach, at least for EOS (https://pubmed.ncbi.nlm.nih.gov/30169482/). We currently have the 48 hours EOS scheme for both, preterm and term infants....hope to reduce the hours of unnecessary antibiotics soon. Concerning the vote: I would not even start antibiotics if an infant is well and asymptomatic (except there are red-flags in the patient history and elevated laboratory parameter - we for example use CRP+IL-6) 🙂 I like the perspective from Joseph Cantey on this topic as well: https://pediatrics.aappublications.org/content/140/4/e20170044.

I'm always wondering that everybody talks about EOS, but I'm much more concerned about LOS....would you do the same in an 600 gram infant at 25 weeks GA at the 9th day of life with suspected sepsis and negative culture at 36 hours? 

[Vicky Payne]

Good question re: LOS! 

I think we probably still would i.e if clinical suspicion was low with negative laboratory parameters e.g. WCC and CRP (though more like 48 hours than 36 perhaps...), but if laboratory parameters are concerning, maybe 5 days with a negative culture......

And I also like the Cantey commentary- nice share!

There is some suggestion that prolonged duration of EOS antibiotics for 'culture negative sepsis' in preterms is associated with increased risk of LOS... https://www.tandfonline.com/doi/full/10.1080/14767058.2018.1481042?casa_token=Opk-yk6TMrgAAAAA%3AzNoO9exu3ovIVBe20ZfN2HXJyPVMhVyT_TiY_J7edvdc-cjBIED-COC5Lu-GyhcRzIvVU8jnYt0

[bimalc]

We have a pharmacist enforced hard stop at 24h on all antibiotics and stewardship review of anything longer than 48h