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Original Paper

Use of Procalcitonin-Guided Decision-Making to Shorten Antibiotic Therapy in Suspected Neonatal Early-Onset Sepsis: Prospective Randomized Intervention Trial

Stocker M.a · Fontana M.a · el Helou S.a · Wegscheider K.b · Berger T.M.a

Author affiliations

aNeonatal and Pediatric Intensive Care Unit, Children’s Hospital of Lucerne, Switzerland, and bDepartment of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany

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Neonatology 2010;97:165–174

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: July 24, 2008
Accepted: February 09, 2009
Published online: September 24, 2009
Issue release date: February 2010

Number of Print Pages: 10
Number of Figures: 2
Number of Tables: 4

ISSN: 1661-7800 (Print)
eISSN: 1661-7819 (Online)

For additional information: https://www.karger.com/NEO

Abstract

Background: Diagnosis of neonatal early-onset sepsis is difficult because clinical signs and laboratory tests are non-specific. Early antibiotic therapy is crucial for treatment success. Objective: To evaluate the effect of procalcitonin (PCT)-guided decision-making on duration of antibiotic therapy in suspected neonatal early-onset sepsis. Methods: This single-center, prospective, randomized intervention study was conducted in a tertiary neonatal and pediatric intensive care unit in the Children’s Hospital of Lucerne, Switzerland, between June 1, 2005 and December 31, 2006. All term and near-term infants (gestational age ≧34 weeks) with suspected early-onset sepsis were randomly assigned either to standard treatment based on conventional laboratory parameters (standard group) or to PCT-guided treatment (PCT group). Minimum duration of antibiotic therapy was 48–72 h in the standard group, whereas in the PCT group antibiotic therapy was discontinued when two consecutive PCT values were below predefined age-adjusted cut-off values. Results: 121 newborns were randomly assigned either to the standard group (n = 61) or the PCT group (n = 60). The two groups were similar for baseline demographics, risk factors for early-onset sepsis, likelihood of infection as assessed by the attending physician and early conventional laboratory findings. There was a significant difference in the proportion of newborns treated with antibiotics ≧72 h between the standard group (82%) and the PCT group (55%) (absolute risk reduction 27%; odds ratio 0.27 (95% CI 0.12–0.62), p = 0.002). On average, PCT-guided decision-making resulted in a shortening of 22.4 h of antibiotic therapy. Clinical outcome was similar and favorable in both groups but sample size was insufficient to exclude rare adverse events. Conclusion:Serial PCT determinations allow to shorten the duration of antibiotic therapy in term and near-term infants with suspected early-onset sepsis. Before this PCT-guided strategy can be recommended, its safety has to be confirmed in a larger cohort of neonates.

© 2009 S. Karger AG, Basel


References

  1. Polin RA: The ‘ins and outs’ of neonatal sepsis. J Pediatr 2003;143:3–4.
  2. Escobar GJ: The neonatal ‘sepsis work-up’: personal reflections on the development of an evidence-based approach toward newborn infections in a managed care organization. Pediatrics 1999;103:e360–e373.
  3. Gendrel D, Bohuon C: Procalcitonin as a marker of bacterial infection. Pediatr Infect Dis J 2000;19:679–688.
  4. Marchini G, Berggren V, Djilali-Merzoug R, Hansson LO: The birth process initiates an acute phase reaction in the fetus-newborn infant. Acta Pediatr 2000;89:1082–1086.
  5. Chiesa C, Panero A, Rossi N, Stegagno M, DeGiusti M, Osborn JF, Pacifico L: Reliability of procalcitonin concentrations for the diagnosis of sepsis in critically ill neonates. Clin Infect Dis 1998;26:664–672.
  6. Assuma M, Signore F, Pacifico L, Rossi N, Osbron JF, Chiesa C: Serum procalcitonin concentrations in term delivering mothers and their healthy offsprings: A longitudinal study. Clin Chem 2000;46:1583–1587.
    External Resources
  7. Guibourdenche J, Bedu A, Petzold L, Marchand M, Mariani-Kurdjian P, Hurtaud-Roux M, Aujard Y, Porquet D: Biochemical markers of neonatal sepsis: value of procalcitonin in the emergency setting. Ann Clin Biochem 2002;39:130–135.
  8. Monneret G, Labaune JM, Isaac C, Beinvenu F, Puter G, Bienvenu J: Procalcitonin and C-reactive protein levels in neonatal infections. Acta Pediatr 1997;86:209–212.
  9. Sachse C, Dressler F, Henkel E: Increased serum procalcitonin in newborn infants without infection. Clin Chem 1998;44:1343–1344.
  10. Turner D, Hammerman C, Rudensky B, Schlesinger Y, Goia C, Schimmel MS: Procalcitonin in preterm infants during the first few days of life: introducing an age-related nomogram. Arch Dis Child Fetal Neonatal Ed 2006;91:F283–F286.
  11. Ballot DE, Perovic O, Galpin J, Cooper PA: Serum procalcitonin as an early marker of neonatal sepsis. S Afr Med J 2004;94:851–854.
  12. Blommendahl J, Janas M, Laine S, Miettinen A, Ashorn P: Comparison of procalcitonin with CRP and differential white blood cell count for diagnosis of culture-proven neonatal sepsis. Scand J Infect Dis 2002;34:620–622.
  13. Distefano G, Curreri R, Betta P, Romeo MG, Amato M: Procalcitonin serum levels in perinatal bacterial and fungal infection of preterm infants. Acta Paediatr 2004;93:216–219.
  14. Enguix A, Rey C, Concha A, Medina A, Coto D, Dieguez MA: Comparison of procalcitonin with C-reactive protein and serum amyloid for the early diagnosis of bacterial sepsis in critically ill neonates and children. Int Care Med 2001;27:211–215.
  15. Franz AR, Kron M, Pohlandt F, Steinbach G: Comparison of procalcitonin with interleukin 8, C-reactive protein and differential white blood cell count for the early diagnosis of bacterial infections in newborn infants. Pediatr Infect Dis J 1999;18:666–671.
  16. Gendrel D, Assicot M, Raymond J, Moulin F, Francouai C, Badoual J, Bohuon C: Procalcitonin as a marker for the early diagnosis of neonatal infection. J Pediatr 1996;128:570–573.
  17. Joram N, Boscher C, Denizot S, Loubersac V, Winer N, Roze JC, Gras-Le Guen C: Umbilical cord blood procalcitonin and C-reactive protein concentrations as markers for early diagnosis of very early onset neonatal infection. Arch Dis Child Fetal Neonatal Ed 2006;91:F65–F66.
  18. Kordek A, Giedrys-Kalemba S, Pawlus B, Podraza W, Czajka R: Umbilical cord blood serum procalcitonin concentration in the diagnosis of early neonatal infection. J Perinatol 2003;23:148–153.
  19. Resch B, Gusenleitner W, Müller WD: Procalcitonin and interleukin-6 in the diagnosis of early-onset sepsis of the neonate. Acta Paediatr 2003;92:243–245.
  20. Meisner M: Pathobiochemistry and clinical use of procalcitonin. Clin Chim Acta 2002;323:17–29.
  21. Connell TG, Rele M, Cowley D, Buttery JP, Curtis N: How reliable is a negative blood culture result? Volume of blood submitted for culture in routine practice in a children’s hospital. Pediatrics 2007;119:891–896.
  22. Nobre V, Harbarth S, Graf JD, Rohner P, Pugin J: Use of procalcitonin to shorten antibiotic treatment duration in septic patients. Am J Respir Crit Care Med 2008;177:498–505.
  23. Philip AG, Mills PC: Use of C-reactive protein in minimizing antibiotic exposure: experience with infants initially admitted to a well-baby nursery. Pediatrics 2000;106:e4.
  24. Ehl S, Gering B, Bartmann P, Högel J, Pohlandt F: C-reactive protein is a useful marker for guiding duration of antibiotic therapy in suspected neonatal bacterial infection. Pediatrics 1997;99:216–221.
  25. Benitz WE, Han MY, Madan A, Ramachandra P: Serial serum C-reactive protein levels in the diagnosis of neonatal infection. Pediatrics 1998;102:e41.
  26. Engle WD, Jackson GL, Sendelbach DM, Stehel EK, Ford DM, McHugh KM, Norris MR, Vedro DA, Velaphi S, Michelow IC, Olsen KD: Pneumonia in term neonates: laboratory studies and duration of antibiotic therapy. J Perinatol 2003;23:372–377.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: July 24, 2008
Accepted: February 09, 2009
Published online: September 24, 2009
Issue release date: February 2010

Number of Print Pages: 10
Number of Figures: 2
Number of Tables: 4

ISSN: 1661-7800 (Print)
eISSN: 1661-7819 (Online)

For additional information: https://www.karger.com/NEO


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