title: Current management of late onset neonatal bacterial sepsis in five European countries.
abstract: Late onset neonatal sepsis (LOS) has a high mortality and the optimal management is poorly defined. We aimed to evaluate new expert panel-derived criteria to define LOS and characterize the current management and antibiotic susceptibility of LOS-causing organisms in Europe. A prospective observational study enrolled infants aged 4 to 90 days in five European countries. Clinical and laboratory findings as well as empiric treatment were recorded and patients were followed until the end of antibiotic therapy. Failure was defined as a change of primary antibiotic, no resolution of clinical signs, appearance of new signs/pathogens or death. Antibiotic therapy was considered appropriate if the organism was susceptible to at least one empiric antibiotic. 113 infants (median age 14 days, 62 % ≤1500 g) were recruited; 61 % were culture proven cases (28 CoNS, 24 Enterobacteriaceae, 11 other Gram-positives and 6 Gram-negative non-fermentative organisms). The predictive value of the expert-panel criteria to identify patients with a culture proven LOS was 61 % (95 % CI 52 % to 70 %). Around one third of Enterobacteriaceae were resistant to ampicillin + or cefotaxime + gentamicin but only 10 % to meropenem. Empiric treatment contained a total of 43 different antibiotic regimens. All-cause mortality was 8 % with an additional 45 % classified as failure of empiric therapy, mainly due to change of primary antibiotics (42/60).
  
  
  CONCLUSIONS
  The expert panel-derived diagnostic criteria performed well identifying a high rate of culture proven sepsis. Current management of LOS in Europe is extremely variable suggesting an urgent need of evidence-based guidelines.
authors: University and University Clinics of Tartu, Tartu, Estonia, irja.lutsar@ut.ee.
authors: Irja
authors: I
authors: Lutsar
authors: Corine
authors: C
authors: Chazallon
authors: Francesca Ippolita Calò
authors: FI
authors: Carducci
authors: Ursula
authors: U
authors: Trafojer
authors: Ben
authors: B
authors: Abdelkader
authors: Vincent Meiffredy
authors: VM
authors: de Cabre
authors: Susanna
authors: S
authors: Esposito
authors: Carlo
authors: C
authors: Giaquinto
authors: Paul T
authors: PT
authors: Heath
authors: Mari-Liis
authors: ML
authors: Ilmoja
authors: Aspasia
authors: A
authors: Katragkou
authors: Carine
authors: C
authors: Lascoux
authors: Tuuli
authors: T
authors: Metsvaht
authors: George
authors: G
authors: Mitsiakos
authors: Emmanuelle
authors: E
authors: Netzer
authors: Lorenza
authors: L
authors: Pugni
authors: Emmanuel
authors: E
authors: Roilides
authors: Yacine
authors: Y
authors: Saidi
authors: Kosmas
authors: K
authors: Sarafidis
authors: Mike
authors: M
authors: Sharland
authors: Vytautas
authors: V
authors: Usonis
authors: Jean-Pierre
authors: JP
authors: Aboulker
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D005060:Europe; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents