564 - Culture Negative Sepsis in the Neonatal Intensive Care Unit: Practice Variation

Poster Number: 564
Publication Number: 564.427

Jina Park, Oregon Health & Science University School of Medicine, Portland, OR, United States; Theodore De Beritto, UCLA Mattel Childrens Hospital, Los Angeles, CA, United States; Angela Douglas, Doernbecher Children's Hospital at Oregon Health & Science University, Portland, OR, United States; Kenneth A. Alexander, University of Central Florida College of Medicine, Orlando, FL, United States; Michael D. Schreiber, University of Chicago Division of the Biological Sciences The Pritzker School of Medicine, Chicago, IL, United States; Joseph R. Hageman, University of Chicago, Chicago, IL, United States

Background: Clinical findings of neonatal sepsis are often nonspecific, making it difficult to diagnose. Because of the high risk of morbidity and mortality, there is a low threshold to evaluate for and treat potential sepsis with empiric antibiotics. However, antibiotic exposure can have adverse effects and current recommendations are to discontinue antibiotics if cultures remain negative at 36-48 hours. Despite this, some neonates are treated with prolonged antibiotics due to concern for “culture negative sepsis.”

Objective: Our aim is to characterize the current national practice variation around the management of culture negative sepsis in the neonatal population.

Design/Methods: A 21 question Qualtrics survey was sent to the members of the Section on Neonatal Perinatal Medicine (SoNPM) listserv of the American Academy of Pediatrics (AAP). Responses were collected over a 7 week period between November and December of 2021.

Results: To date, there are 584 fully completed surveys (15% response rate). 90% of respondents were neonatologists and 92.5% practiced in either level 3 or 4 NICU. 85% indicated there is no standard definition of culture negative sepsis at their center and 80% did not have standardized guidelines for the management of this diagnosis.
 
The top three reasons for continuation of antibiotics despite negative blood cultures were: (1) clinical status of patient, (2) elevated biomarkers suggestive of inflammation and (3) presence of central lines or hardware that may increase risk of infection. Most (57%) treat for 7 days including the rule out period, with 28% and 12% reporting 5 days and 3 days respectively (fig. 1). 63% reported using biomarkers to help guide decision making around antibiotic duration, and a wide range of different biomarkers are utilized (fig. 2). 84% reported obtaining follow up labs after the diagnosis is made (28% always, 56% sometimes); 9% obtain a repeat blood culture (fig. 3).Conclusion(s): Though there are recommendations against the diagnosis and treatment of culture negative sepsis, the practice continues. There is not consensus on the definition of culture negative sepsis in a majority of NICU centers with variable antibiotic duration and follow up lab practices.
 
Until the diagnosis can be eliminated completely, there is a need for a more unifying definition and guidance on the management of culture negative sepsis. Given the increased incidence of negative outcomes in neonates who receive prolonged antibiotics as well as the importance of antibiotic stewardship, standardization of antibiotic duration is one area that can be improved.
Figure 1Antibiotic duration in culture negative sepsis
FIgure 2Biomarkers for antibiotic duration