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OASCN Resources | Late-Onset & Culture-Negative Sepsis

These resources were developed by the OASCN Collaborative between 2021-2022.

Relevant Didactics:

  • Use of Inflammatory Markers for Evaluating Early and Late Onset Sepsis (Bill Benitz): Slides | Video
  • Naming the Problem That Underpins “Rule-out Sepsis” - The Need for Bayesian Thinking (Joseph Schulman): Slides | Video
  • Is That Bug a Pathogen or Poseur? (Ken Zangwill): Slides | Video
  • Antibacterial Drugs for EOS (Jason Sauberan): Slides | Video
  • Duration of Empiric Antibiotic Therapy for Neonatal Sepsis: How much is Enough? (Ken Zangwill): Slides | Video
  • Antimicrobial Stewardship in Preterm Infants (Bill Benitz): Slides | Video

Relevant Learning Points:

Learning Point #26: Differentiating “sepsis” caused by infection from the physiologic changes associated with extreme prematurity is challenging, but strongly considering the latter is very important.

  • Persistent cardiorespiratory instability is NOT an indication for prolonged empiric antibiotics.
  • Clinical evaluation should occur each day without a definitive “treatment course” determined on day 1 necessarily.

Learning Point #27: Strongly consider doing a respiratory nasal PCR test in rule out LOS babies. Blood PCR for enterovirus also may help identify cause eof clinical signs, especially if in the summer/fall season.

Learning Point #28: Double gram negative coverage for sepsis is unnecessary. Data from older children and adults do not support this practice (some recommend only for pseudomonas sepsis/VAP in adults).

Relevant References: 

Piantino JH et al. Culture-negative sepsis and systemic inflammatory response syndrome in neonates. NeoReviews 2013;14:c294.

Sanchez P et al. Empiric therapy with vancomycin in the neonatal intensive care unit: let's "get smart" globally! J Pediatr (Rio J) 2016;92:432.

Chu A et al. Antimicrobial therapy and late-onset sepsis. NeoReviews 2012;13:e94.