Background Sepsis remains one of the biggest causes of neonatal morbidity and mortality. The antibiotic guidelines used on our NICU are influenced heavily by national epidemiological data from NeonIN, collected from 2006–2008. The objective of this service improvement project was to establish the current epidemiology of bacteraemia-causing pathogens on our unit, and their sensitivity to our empirical antibiotic regimens, in order to establish whether our guidelines remain adequate.
Methods Laboratory data on positive blood cultures from April 2011 to March 2014 were analysed. We established the common pathogens, their incidence, and their sensitivity to recommended empirical antibiotics.
Results Out of 2367 blood cultures analysed, 116 (5%) were positive for an organism. These were made up of 70 (60%) Coagulase Negative Staphylococcus, 13 (11%) Group B Streptococcus, 12 (10%) coliforms, 8 (7%) Enterococcus faecalis and 6 (5%) Staphylococcus aureus. The remaining were rarer Gram positive organisms and 1 Haemophilus influenzae. 100% of organisms that commonly cause early-onset sepsis (GBS and Escherichia coli n = 19) were sensitive to the recommended antibiotic combination of penicillin and gentamycin. 100% of non- CoNS pathogens were sensitive to the Amoxicillin and/or Gentamycin in the late onset sepsis regimen of Amoxicillin/Flucloxacillin/Gentamycin. Sensitivity to Flucloxacillin was measured at 22% of positive cultures tested. Only 54% of CoNS was tested for sensitivity to Vancomycin, which is the recommended antibiotic for suspected CoNS (eg. central line in situ). 100% of these were sensitive.
Conclusions Initial analysis shows that guidelines are appropriate for early-onset sepsis and non-CoNS late-onset sepsis. However, the data questions the need for Flucloxacillin in the LOS regimen. There is apparent inconsistency in testing of CoNS for sensitivity to Vancomycin, not allowing a full judgement as to whether this provides adequate cover. The need for Ceftazidime (recommended with Vancomycin when a baby remains sick despite the Amoxicillin/Flucloxacillin/Gentamycin regimen) is questioned by this study.
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