Skip to main content
SpringerLink
Log in

Management of early- and late-onset sepsis: results from a survey in 80 German NICUs

  • Original Paper
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Purpose

The management of early- (EOS) and late-onset sepsis (LOS) and neonatal intensive care units (NICUs) has not been extensively evaluated.

Methods

231 highly specialized level 1 and level 2 NICUs in Germany were asked to participate in an internet-based survey.

Results

The final analysis of anonymized datasets from 80 NICUs (response rate 34.6 %) compared university hospitals and regional neonatal referral centers. The survey describes potential areas of improvement concerning empirical treatment of infants with LOS with vancomycin and 3rd generation cephalosporins, minimal volume of blood sampling for aerobic culture, consideration of lumbar tap in any child with blood culture positive LOS and drug monitoring details for gentamicin and vancomycin.

Conclusion

In summary, this survey reveals a significant gap between recent national German guidelines and daily practices in German NICUs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Troger B, Gopel W, Faust K, et al. Risk for late-onset blood-culture proven sepsis in very-low-birth weight infants born small for gestational age: a large multicenter study from the German Neonatal Network. Pediatr Infect Dis J. 2014;33:238–43.

    Article  PubMed  Google Scholar 

  2. Stichtenoth G, Demmert M, Bohnhorst B, et al. Major contributors to hospital mortality in very-low-birth-weight infants: data of the birth year 2010 cohort of the German Neonatal Network. Klin Padiatr. 2012;224:276–81.

    Article  CAS  PubMed  Google Scholar 

  3. Alshaikh B, Yusuf K, Sauve R. Neurodevelopmental outcomes of very low birth weight infants with neonatal sepsis: systematic review and meta-analysis. J Perinatol. 2013;33:558–64.

    Article  CAS  PubMed  Google Scholar 

  4. Reichert F, Piening B, Geffers C, Gastmeier P, Buhrer C, Schwab F. Pathogen-specific clustering of nosocomial blood stream infections in very preterm infants. Pediatrics. 2016;137:e 20152860.

    Article  Google Scholar 

  5. Leistner R, Piening B, Gastmeier P, Geffers C, Schwab F. Nosocomial infections in very low birthweight infants in Germany: current data from the national surveillance system NEO-KISS. Klin Padiatr. 2013;225:75–80.

    Article  CAS  PubMed  Google Scholar 

  6. Cantey JB, Ronchi A, Sanchez PJ. Spreading the benefits of infection prevention in the neonatal intensive care unit. JAMA Pediatr. 2015;169:1089–91.

    Article  PubMed  Google Scholar 

  7. Kermorvant-Duchemin E, Laborie S, Rabilloud M, Lapillonne A, Claris O. Outcome and prognostic factors in neonates with septic shock. Pediatr Crit Care Med. 2008;9:186–91.

    Article  PubMed  Google Scholar 

  8. Patel SJ, Green N, Clock SA, et al. Gram-Negative Bacilli in infants hospitalized in the neonatal intensive care unit. J Pediatric Infect Dis Soc. 2017;6:227–30.

    PubMed  Google Scholar 

  9. Cantey JB. Optimizing the use of antibacterial agents in the neonatal period. Paediatr Drugs. 2016;18:109–22.

    Article  PubMed  Google Scholar 

  10. Cantey JB, Milstone AM. Bloodstream infections: epidemiology and resistance. Clin Perinatol. 2015;42:1–16 (vii).

    Article  PubMed  Google Scholar 

  11. Cantey JB, Patel SJ. Antimicrobial stewardship in the NICU. Infect Dis Clin North Am. 2014;28:247–61.

    Article  PubMed  Google Scholar 

  12. Cantey JB, Wozniak PS, Pruszynski JE, Sanchez PJ. Reducing unnecessary antibiotic use in the neonatal intensive care unit (SCOUT): a prospective interrupted time-series study. Lancet Infect Dis. 2016;16:1178–84.

    Article  PubMed  Google Scholar 

  13. Cantey JB, Wozniak PS, Sanchez PJ. Prospective surveillance of antibiotic use in the neonatal intensive care unit: results from the SCOUT study. Pediatr Infect Dis J. 2015;34:267–72.

    Article  PubMed  Google Scholar 

  14. Lutsar I, Chazallon C, Carducci FI, et al. Current management of late onset neonatal bacterial sepsis in five European countries. Eur J Pediatr. 2014;173:997–1004.

    CAS  PubMed  Google Scholar 

  15. Fernando AM, Heath PT, Menson EN. Antimicrobial policies in the neonatal units of the United Kingdom and Republic of Ireland. J Antimicrob Chemother. 2008;61:743–5.

    Article  CAS  PubMed  Google Scholar 

  16. Liem TB, Krediet TG, Fleer A, Egberts TC, Rademaker CM. Variation in antibiotic use in neonatal intensive care units in the Netherlands. J Antimicrob Chemother. 2010;65:1270–5.

    Article  CAS  PubMed  Google Scholar 

  17. Kadambari S, Heath PT, Sharland M, Lewis S, Nichols A, Turner MA. Variation in gentamicin and vancomycin dosage and monitoring in UK neonatal units. J Antimicrob Chemother. 2011;66:2647–50.

    Article  CAS  PubMed  Google Scholar 

  18. Leroux S, Zhao W, Betremieux P, Pladys P, Saliba E, Jacqz-Aigrain E. Therapeutic guidelines for prescribing antibiotics in neonates should be evidence-based: a French national survey. Arch Dis Child. 2015;100:394–8.

    Article  PubMed  Google Scholar 

  19. Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut B; Ergänzende E. zur “Prävention nosokomialer Infektionen bei neonatologischen Intensivpflegepatienten mit einem Geburtsgewicht unter 1.500 g” (2007). Epidemiol Bulletin des Robert Koch-Instituts, Berlin. 2012;(16. January 2012/Nr. 2):13–15.

  20. Christoph J, Dame C, Eckmanns T, et al. Risikocharakterisierung intensivmedizinisch behandelter Früh- und Neugeborener und Daten zur Ist-Situation in deutschen neonatologischen Intensivpflegestationen 2013 - Fachliche Erläuterungen zu folgender Empfehlung: Praktische Umsetzung sowie krankenhaushygienische und infektionspräventive Konsequenzen des mikrobiellen Kolonisationsscreenings bei intensivmedizinisch behandelten Früh- und Neugeborenen Ergänzende Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut, Berlin zur Implementierung der Empfehlungen zur Prävention nosokomialer Infektionen bei neonatologischen Intensivpflegepatienten mit einem Geburtsgewicht unter 1.500 g aus dem Jahr 2007 und 2012 (Epidemiologisches Bulletin 42/2013). Epidemiol Bulletin des Robert Koch-Instituts, Berlin 2013;Supplement zu Ausgabe 42(21. Oktober 2013).

  21. Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut B. Praktische Umsetzung sowie krankenhaushygienische und infektionspräventive Konsequenzen des mikrobiellen Kolonisationsscreenings bei intensivmedizinisch behandelten Früh- und Neugeborenen -Ergänzende Empfehlung der KRINKO beim Robert Koch-Institut, Berlin, zur Implementierung der Empfehlungen zur Prävention nosokomialer Infektionen bei neonatologischen Intensivpflegepatienten mit einem Geburtsgewicht unter 1.500 g aus dem Jahr 2007 und 2012. Epidemiol Bulletin des Robert Koch-Instituts, Berlin. 2013;Nr. 42(21. Oktober 2013):421–433.

  22. Smith A, Saiman L, Zhou J, Della-Latta P, Jia H, Graham PL. Concordance of gastrointestinal tract colonization and subsequent bloodstream infections with Gram-negative Bacilli in very low birth weight infants in the neonatal intensive care unit. Pediatr Infect Dis J. 2010;29:831–5.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Haertel C, Simon A, Geffers C, et al. Nosokomiale Infektionen bei Frühgeborenen—Umsetzung der KRINKO-Empfehlungen im Deutschen Frühgeborenennetzwerk. Monatsschr Kinderheilkd. 2013;161:27–33.

    Article  Google Scholar 

  24. Deutsche Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin. Deutsche Gesellschaft für Pädiatrische Infektiologie, Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Arbeitsgemeinschaft der wissenschaftlichen Fachgesellschaften (AWMF). Bakterielle Infektionen bei Neugeborenen. AWMF Register No 024—008 2018; 30.04.2018.

  25. Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut. Definition der Multiresistenz gegenüber Antibiotika bei gramnegativen Stäbchen im Hinblick auf Maßnahmen zur Vermeidung der Weiterverbreitung. Epidemiol Bull des Robert Koch-Instituts Berlin. 2011;12:337–9.

    Google Scholar 

  26. Cunningham CT, Quan H, Hemmelgarn B, et al. Exploring physician specialist response rates to web-based surveys. BMC Med Res Methodol 2015;1532.

  27. Gemeinsamer Bundesausschuss (GbA). Beschluss des Gemeinsamen Bundesausschusses über eine Änderung der Qualitätssicherungs-Richtlinie Früh- und Reifgeborene/QFR-RL: (§ 7 Nachweisverfahren und Anlage 2 Anforderung zum Pflegepersonal) 2016;15. Dezember 2016. http://www.english.g-ba.de/.

  28. Polin RA. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics. 2012;129:1006–15.

    Article  PubMed  Google Scholar 

  29. Mukherjee A, Davidson L, Anguvaa L, Duffy DA, Kennea N. NICE neonatal early onset sepsis guidance: greater consistency, but more investigations, and greater length of stay. Arch Dis Child Fetal Neonatal Ed. 2015;100:F248–9.

    Article  PubMed  Google Scholar 

  30. Mukherjee A, Ramalingaiah B, Kennea N, Duffy DA. Management of neonatal early onset sepsis (CG149): compliance of neonatal units in the UK with NICE recommendations. Arch Dis Child Fetal Neonatal Ed. 2015;100:F185.

    Article  PubMed  Google Scholar 

  31. Denkel LA, Schwab F, Kola A, et al. The mother as most important risk factor for colonization of very low birth weight (VLBW) infants with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E). J Antimicrob Chemother. 2014;69:2230–7.

    Article  CAS  PubMed  Google Scholar 

  32. Patel SJ, Oshodi A, Prasad P, et al. Antibiotic use in neonatal intensive care units and adherence with centers for disease control and prevention 12 step campaign to prevent antimicrobial resistance. Pediatr Infect Dis J. 2009;28:1047–51.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Spyridis N, Syridou G, Goossens H, et al. Variation in paediatric hospital antibiotic guidelines in Europe. Arch Dis Child. 2016;2016:72–6.

    Article  Google Scholar 

  34. Ericson JE, Thaden J, Cross HR, et al. No survival benefit with empirical vancomycin therapy for coagulase-negative staphylococcal bloodstream infections in infants. Pediatr Infect Dis J. 2015;34:371–5.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Thaden JT, Ericson JE, Cross H, et al. Survival benefit of empirical therapy for Staphylococcus aureus bloodstream infections in infants. Pediatr Infect Dis J. 2015;34:1175–9.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Popoola VO, Colantuoni E, Suwantarat N, et al. Active surveillance cultures and decolonization to reduce staphylococcus aureus infections in the neonatal intensive care unit. Infect Control Hosp Epidemiol. 2016;37:381–7.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Wisgrill L, Zizka J, Unterasinger L, et al. Active surveillance cultures and targeted decolonization are associated with reduced methicillin-susceptible Staphylococcus aureus infections in VLBW infants. Neonatology. 2017;112:267–73.

    Article  CAS  PubMed  Google Scholar 

  38. Holzmann-Pazgal G, Khan AM, Northrup TF, Domonoske C, Eichenwald EC. Decreasing vancomycin utilization in a neonatal intensive care unit. Am J Infect Control. 2015;43:1255–7.

    Article  PubMed  Google Scholar 

  39. Le J, Nguyen T, Okamoto M, McKamy S, Lieberman JM. Impact of empiric antibiotic use on development of infections caused by extended-spectrum beta-lactamase bacteria in a neonatal intensive care unit. Pediatr Infect Dis J. 2008;27:314–8.

    Article  PubMed  Google Scholar 

  40. Stocker M, Ferrao E, Banya W, Cheong J, Macrae D, Furck A. Antibiotic surveillance on a paediatric intensive care unit: easy attainable strategy at low costs and resources. BMC Pediatr 2012;12196.

  41. Simon A, Tenenbaum T. Surveillance of multidrug-resistant Gram-negative pathogens in high-risk neonates-does it make a difference? Pediatr Infect Dis J. 2013;32:407–9.

    Article  PubMed  Google Scholar 

  42. Seidel J, Haller S, Eckmanns T, Harder T. Routine screening for colonization by Gram-negative bacteria in neonates at intensive care units for the prediction of sepsis: systematic review and meta-analysis. J Hosp Infect. 2018 (in press).

  43. Folgori L, Tersigni C, Hsia Y, et al. The relationship between Gram-negative colonization and bloodstream infections in neonates: a systematic review and meta-analysis. Clin Microbiol Infect. 2018;24:251–7.

    Article  CAS  PubMed  Google Scholar 

  44. Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch Institut Berlin. Prävention von Gefäßkatheter-assoziierten Infektionen bei Früh- und Neugeborenen—Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robeert Koch Instituut. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2018;61:608–26.

    Article  Google Scholar 

  45. Dien Bard J, McElvania TeKippe E. Diagnosis of bloodstream infections in children. J Clin Microbiol. 2016;54:1418–24.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Berger A, Rohrmeister K, Haiden N, Assadian O, Kretzer V, Kohlhauser C. Serratia marcescens in the neonatal intensive care unit: re-emphasis of the potentially devastating sequelae. Wien Klin Wochenschr. 2002;114:1017–22.

    CAS  PubMed  Google Scholar 

  47. Pineda LC, Watt KM. New antibiotic dosing in infants. Clin Perinatol. 2015;42:167–76 (ix–x).

    Article  PubMed  Google Scholar 

  48. Pauwels S, Allegaert K. Therapeutic drug monitoring in neonates. Arch Dis Child. 2016;101:377–81.

    Article  PubMed  Google Scholar 

  49. Fonzo-Christe C, Guignard B, Zaugg C, et al. Impact of clinical decision support guidelines on therapeutic drug monitoring of gentamicin in newborns. Ther Drug Monit. 2014;36:656–62.

    Article  CAS  PubMed  Google Scholar 

  50. Fuchs A, Guidi M, Giannoni E, et al. Population pharmacokinetic study of gentamicin in a large cohort of premature and term neonates. Br J Clin Pharmacol. 2014;78:1090–101.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Antolik TL, Cunningham KJ, Alabsi S, Reimer RA. Empirical gentamicin dosing based on serum creatinine levels in premature and term neonates. Am J Health Syst Pharm. 2017;74:466–72.

    Article  CAS  PubMed  Google Scholar 

  52. Frymoyer A, Hersh AL, El-Komy MH, et al. Association between vancomycin trough concentration and area under the concentration-time curve in neonates. Antimicrob Agents Chemother. 2014;58:6454–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Cole TS, Riordan A. Vancomycin dosing in children: what is the question? Arch Dis Child. 2013;98:994–7.

    Article  PubMed  Google Scholar 

  54. Ringenberg T, Robinson C, Meyers R, et al. Achievement of therapeutic vancomycin trough serum concentrations with empiric dosing in neonatal intensive care unit patients. Pediatr Infect Dis J. 2015;34:742–7.

    Article  PubMed  Google Scholar 

  55. Lestner JM, Hill LF, Heath PT, Sharland M. Vancomycin toxicity in neonates: a review of the evidence. Curr Opin Infect Dis. 2016;29:237–47.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Our thanks go to all participating neonatologists and to the members of the KRINKO working group “Neonatal intensive care”: Dr. Jürgen Christoph, Prof. Dr. Christof Dame, Prof. Dr. Christine Geffers, Prof. Dr. Christian Gille, Prof. Dr. Irene Krämer, Dr. Matthias Marschal, Prof. Dr. Andreas Müller, and Prof. Dr. Mardjan Arvand and Vanda Marujo (Robert Koch Institute). We thankfully acknowledge the help of Gudrun Wagenpfeil concerning statistical analysis.

Funding

The German Society for Pediatric Infectious Diseases (DGPI) actively promoted the distribution of the survey (website and E-Mail invitation) and provided the technical prerequisites (Survey Monkey™).

Author information

Author notes

  1. Jana E. Litz and Sybelle Goedicke-Fritz contributed equally to this publication.

Authors and Affiliations

  1. General Pediatrics and Neonatology, Children’s Hospital Medical Center, University Hospital of Saarland, Homburg, Germany

    Jana E. Litz, Sybelle Goedicke-Fritz & Michael Zemlin

  2. Department of Pediatrics, Children’s Hospital, University of Luebeck, Lübeck, Germany

    Christoph Härtel

  3. Department of Pediatric Hematology and Oncology, Children’s Hospital Medical Center, University Hospital of Saarland, Gebäude 9, Kirrberger Straße, 66421, Homburg/Saar, Germany

    Arne Simon

Authors
  1. Jana E. Litz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sybelle Goedicke-Fritz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christoph Härtel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Zemlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Arne Simon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arne Simon.

Ethics declarations

Conflict of interest

Arne Simon is the second chair of the German Commission for Hospital Hygiene and Infection Prevention (KRINKO) affiliated at the Robert Koch Institute, Berlin, and coordinates the KRINKO working group “Neonatal Intensive Care”. Michael Zemlin is the coordinator of the AWMF Recommendation “Neonatale Sepsis” (AWMF Registration Number 024/008) lead-managed by the German Society of Pediatric and Neonatal Intensive Care (GNPI). Christoph Haertel is a member of the KRINKO working group “Neonatal Intensive Care” and co-authored the AWMF Recommendation “Neonatale Sepsis” (AWMF Registration Number 024/008).

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 33 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Litz, J.E., Goedicke-Fritz, S., Härtel, C. et al. Management of early- and late-onset sepsis: results from a survey in 80 German NICUs. Infection 47, 557–564 (2019). https://doi.org/10.1007/s15010-018-1263-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-018-1263-9

Keywords

Search

Navigation