Sepsis related mortality of extremely low gestational age newborns after the introduction of colonization screening for
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(2020) 9:144
RESEARCH
Open Access
Sepsis related mortality of extremely low gestational age newborns after the introduction of colonization screening for multi-drug resistant organisms Christoph Härtel1,2,3,4,5*, Kirstin Faust1,2 , Ingmar Fortmann1, Alexander Humberg1,2, Julia Pagel1,2, Clara Haug1, Reinhard Kühl3,6, Bettina Bohnhorst3,7, Sabine Pirr4,7, Dorothee Viemann4,7, Arne Simon3,8, Michael Zemlin3,4,8, Silvia Poralla3,9, Andreas Müller3,9, Natascha Köstlin-Gille10, Christian Gille3,4,10, Matthias Heckmann3,11, Jan Rupp2,12, Egbert Herting1,3,4 and Wolfgang Göpel1,3,4
Abstract Background: In 2013 German infection surveillance guidelines recommended weekly colonization screening for multidrug-resistant (MDRO) or highly epidemic organisms for neonatal intensive care units (NICUs) and extended hygiene measures based on screening results. It remains a matter of debate whether screening is worth the effort. We therefore aimed to evaluate sepsis related outcomes before and after the guideline update. Methods: The German Neonatal Network (GNN) is a prospective cohort study including data from extremely preterm infants between 22 + 0 and 28 + 6 gestational weeks born in 62 German level III NICUs. Results: Infants treated after guideline update (n = 8.903) had a lower mortality (12.5% vs. 13.8%, p = 0.036), reduced rates for clinical sepsis (31.4 vs. 42.8%, p < 0.001) and culture-proven sepsis (14.4% vs. 16.5%, p = 0.003) as compared to infants treated before update (n = 3.920). In a multivariate logistic regression analysis, nine pathogens of cultureproven sepsis were associated with sepsis-related death, e.g. Pseudomonas aeruginosa [OR 59 (19–180), p < 0.001)]. However, the guideline update had no significant effect on pathogen-specific case fatality, total sepsis-related mortality and culture-proven sepsis rates with MDRO. While the exposure of GNN infants to cefotaxime declined over time (31.1 vs. 40.1%, p < 0.001), the treatment rate with meropenem was increased (31.6 vs. 26.3%, p < 0.001). Conclusions: The introduction of weekly screening and extended hygiene measures is associated with reduced sepsis rates, but has no effects on sepsis-related mortality and sepsis with screening-relevant pathogens. The high exposure rate to meropenem should be a target of antibiotic stewardship programs. Keywords: Colonization screening, Multi-drug resistant organisms, Extremely preterm infants, Sepsis, Sepsis mortality, Preterm infant
* Correspondence: [email protected] 1 Department of Pediatrics, University of Lübeck, Lübeck, Germany 2 German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Lübeck, Germany Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to th
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