Antimicrobial Resistance and Infection Control (Aug 2020)

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

  • 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

DOI
https://doi.org/10.1186/s13756-020-00804-8
Journal volume & issue
Vol. 9, no. 1
pp. 1 – 9

Abstract

Read online

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.

Keywords