Superficial cultures in neonatal sepsis evaluations: impact on antibiotic decision making

The cause of neonatal sepsis must be rapidly identified and treated because the condition of a sick young newborn can rapidly deteriorate. Depending on the apparent nature of the sepsis, deep cultures (blood and cerebrospinal fluid), or superficial cultures (from gastrointestinal aspirate, external ear canal and umbilicus drainage) are taken to determine the cause of infection and sepsis, and antibiotic therapy. To explore the role that these culture results play in managing antibiotic therapy, a retrospective review was undertaken. The medical records of 66 infants with early onset neonatal sepsis were studied. All infants had deep cultures taken shortly after birth, and prior to the administration of antibiotics. Superficial cultures were also collected. Factors taken into consideration included: the source and results of each culture, and the time and date reported; antibiotics used, dosage and duration of treatment; and the clinical course of the infant. The impact and influence of superficial cultures on the antibiotic regimen was positive if: antibiotics were changed after a positive superficial culture report and negative deep cultures; the antibiotic regimen was altered after a positive superficial culture report, regardless of deep culture status; and the antibiotic regimen was not changed after positive superficial culture report, negative deep cultures, and clinical well being. The principal outcome of this study revealed that, based on superficial cultures, no decision impact was felt in the antibiotic treatment of 98 percent of the neonates and 90 percent of those with positive superficial cultures. The value, if any, of the superficial cultures should be thoroughly reviewed. (Consumer Summary produced by Reliance Medical Information, Inc.)