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Published in: Antimicrobial Resistance & Infection Control 1/2020

Open Access 01-12-2020 | Septicemia | Research

Sepsis related mortality of extremely low gestational age newborns after the introduction of colonization screening for multi-drug resistant organisms

Authors: Christoph Härtel, Kirstin Faust, Ingmar Fortmann, Alexander Humberg, Julia Pagel, Clara Haug, Reinhard Kühl, Bettina Bohnhorst, Sabine Pirr, Dorothee Viemann, Arne Simon, Michael Zemlin, Silvia Poralla, Andreas Müller, Natascha Köstlin-Gille, Christian Gille, Matthias Heckmann, Jan Rupp, Egbert Herting, Wolfgang Göpel

Published in: Antimicrobial Resistance & Infection Control | Issue 1/2020

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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 culture-proven 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.
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Metadata
Title
Sepsis related mortality of extremely low gestational age newborns after the introduction of colonization screening for multi-drug resistant organisms
Authors
Christoph Härtel
Kirstin Faust
Ingmar Fortmann
Alexander Humberg
Julia Pagel
Clara Haug
Reinhard Kühl
Bettina Bohnhorst
Sabine Pirr
Dorothee Viemann
Arne Simon
Michael Zemlin
Silvia Poralla
Andreas Müller
Natascha Köstlin-Gille
Christian Gille
Matthias Heckmann
Jan Rupp
Egbert Herting
Wolfgang Göpel
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Antimicrobial Resistance & Infection Control / Issue 1/2020
Electronic ISSN: 2047-2994
DOI
https://doi.org/10.1186/s13756-020-00804-8

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