Antimicrobial therapy in newborns: from theory to practice
https://doi.org/10.31146/2949-4664-apps-2-2-80-90
Abstract
Currently, there are no uniform accurate statistical data on the development of neonatal sepsis. This critical condition is difficult to diagnose in the early stages due to the lack of reliable markers with high prognostic value, and the use of currently available sepsis markers with high specificity and/or sensitivity is limited to large tertiary level obstetric hospitals. In this regard, as part of the early diagnosis of neonatal sepsis, issues related to amultifactorial assessment of the risk of neonatal sepsis becoming relevant, on the basis of which indications for prescribing therapy for the prevention of this condition will be justified. The most common etiological cause of sepsis is numerous pathogens: bacteria, viruses and fungi. This again leaves difficulties in choosing the right therapeutic tactics, especially within the framework of antibiotic therapy, the protocols of which vary from hospital to hospital not only in our country, but throughout the world. Based on the practice of domestic and foreign colleagues, it is necessary to discuss protocols for the management of patients with such acomplex diagnosis as sepsis.
About the Authors
S. N. Lavrentyev
Reasearch Clinical Institute of Childhood of the Ministry of Health of the Moscow Region; Moscow Regional Perinatal Center
Russian Federation
Russian Federation
A. S. Petrova
Reasearch Clinical Institute of Childhood of the Ministry of Health of the Moscow Region; Moscow Regional Perinatal Center
Russian Federation
Russian Federation
T. S. Lyulka
Russian National Research Medical University named after N. I.Pirogov
Russian Federation
Russian Federation
E. V. Loshkova
Reasearch Clinical Institute of Childhood of the Ministry of Health of the Moscow Region; Scientific institution Medical Genetic Research Center named after Academican N. P. Bochkov
Russian Federation
Russian Federation
References
1. Fleischmann-Struzek C., Goldfarb D. M., Schlattmann P., Schlapbach L. J., Reinhart K., Kissoon N. The global burden of paediatric and neonatal sepsis: asystematic review. Lancet Respir Med. 2018 Mar;6(3):223-230. doi: 10.1016/S2213-2600(18)30063-8.
2. Wynn J.L., Wong H. R.Pathophysiology of Neonatal Sepsis. Fetal and Neonatal Physiology. 2017:1536-1552.e10. doi: 10.1016/B978-0-323-35214-7.00152-9.
3. Shane A.L., SánchezP. J., StollB. J.Neonatal sepsis. Lancet. 2017 Oct 14;390(10104):1770-1780. doi: 10.1016/S0140-6736(17)31002-4.
4. Verboon-Maciolek M.A., KredietT. G., GerardsL. J., Fleer A., van LoonT. M.Clinical and epidemiologic characteristics of viral infections in aneonatal intensive care unit during a12-year period. Pediatr Infect Dis J. 2005 Oct;24(10):901-4. doi: 10.1097/01.inf.0000180471.03702.7f.
5. Braye K., Foureur M., de Waal K., Jones M., Putt E., FergusonJ. Epidemiology of neonatal early-onset sepsis in ageographically diverse Australian health district 2006-2016. PLoS One. 2019 Apr 8;14(4): e0214298. doi: 10.1371/journal.pone.0214298.
6. Stoll B.J., Puopolo K. M., Hansen N. I., Sánchez P. J., Bell E. F., Carlo W. A., Cotten C. M., D’Angio C.T., KazziS. N.J., Poindexter B. B., Van Meurs K. P., Hale E. C., Collins M. V., Das A., Baker C. J., Wyckoff M. H., Yoder B. A., Watterberg K. L., Walsh M. C., Devaskar U., LaptookA. R., Sokol G. M., Schrag S. J., Higgins R. D.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Early-Onset Neonatal Sepsis 2015 to 2017, the Rise of Escherichia coli, and the Need for Novel Prevention Strategies. JAMA Pediatr. 2020 Jul 1;174(7): e200593. doi: 10.1001/jamapediatrics.2020.0593. Epub 2020 Jul 6. Erratum in: JAMA Pediatr. 2021 Feb 1;175(2):212. doi: 10.1001/jamapediatrics.2020.6111.
7. Goldenberg R.L., Culhane J. F., Iams J. D., Romero R. Epidemiology and causes of preterm birth. Lancet. 2008 Jan 5;371(9606):75-84. doi: 10.1016/S0140-6736(08)60074-4.
8. Puopolo K.M., Benitz W. E., Zaoutis T. E.; COMMITTEE ON FETUS AND NEWBORN; COMMITTEE ON INFECTIOUS DISEASES. Management of Neonates Born at ≥35 0/7Weeks’ Gestation With Suspected or Proven Early-Onset Bacterial Sepsis. Pediatrics. 2018 Dec;142(6): e20182894. doi: 10.1542/peds.2018-2894.
9. Greenberg R.G., Kandefer S., Do B. T., Smith P. B., Stoll B. J., Bell E. F., Carlo W. A., Laptook A. R., Sánchez P. J., Shankaran S., Van Meurs K. P., Ball M. B., Hale E. C., Newman N. S., Das A., Higgins R. D., Cotten C. M.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Late-onset Sepsis in Extremely Premature Infants: 2000-2011. Pediatr Infect Dis J. 2017 Aug;36(8):774-779. doi: 10.1097/INF.0000000000001570.
10. Breiman R.F., Blau D. M., Mutevedzi P., Akelo V., Mandomando I., Ogbuanu I. U. et al. Postmortem investigations and identification of multiple causes of child deaths: An analysis of findings from the Child Health and Mortality Prevention Surveillance (CHAMPS) network. PLoS Med. 2021;18: e1003814. doi: 10.1371/journal.pmed.1003814.
11. Whitley R., Arvin A., Prober C. et al. Predictors of morbidity and mortality in neonates with herpes simplex virus infections. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. N Engl J Med. 1991 Feb 14;324(7):450-4. doi: 10.1056/NEJM199102143240704.
12. Kim S.J., Kim G. E., Park J. H., Lee S. L., Kim C. S. Clinical features and prognostic factors of early-onset sepsis: a7.5-year experience in one neonatal intensive care unit. Korean J Pediatr. 2019 Jan;62(1):36-41. doi: 10.3345/kjp.2018.06807.
13. Bai L., Gong P., JiaX., ZhangX., LiX., Zhang Y., Zhou H., KangY.Comparison of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio for the diagnosis of neonatal sepsis: asystematic review and meta-analysis. BMC Pediatr. 2023 Jun 30;23(1):334. doi: 10.1186/s12887-023-04094-y.
14. Bochud P.Y., GlauserM. P., Calandra T.; International Sepsis Forum. Antibiotics in sepsis.Intensive Care Med. 2001;27 Suppl1: S33-48. doi: 10.1007/pl00003796.
15. Fuchs A., Bielicki J., Mathur S., Sharland M., Van Den AnkerJ. N.Reviewing the WHO guidelines for antibiotic use for sepsis in neonates and children. Paediatr Int Child Health. 2018;38: S3-S15. doi: 10.1080/20469047.2017.1408738.
16. Sikias P., BiranV., Foix-L’Hélias L., Plainvert C., Boileau P., Bonacorsi S.; EOS study group. Early-onset neonatal sepsis in the Paris area: apopulation-based surveillance study from 2019 to 2021. Arch Dis Child Fetal Neonatal Ed. 2023 Mar;108(2):114-120. doi: 10.1136/archdischild-2022-324080.
17. Lin L.L., HungJ. N., ShiuS. I., SuY. H., ChenW. C., TsengJ. J.Efficacy of prophylactic antibiotics for preterm premature rupture of membranes: asystematic review and network meta-analysis. Am J Obstet Gynecol MFM. 2023 Jul;5(7):100978. doi: 10.1016/j.ajogmf.2023.100978.
18. Randis T.M., Rice M. M., Myatt L., Tita A. T.N., Leveno K. J., Reddy U. M., Varner M. W., Thorp J. M., Mercer B. M., Dinsmoor M. J., Ramin S. M., Carpenter M. W., Samuels P., Sciscione A., TolosaJ. E., Saade G., Sorokin Y.; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Incidence of early-onset sepsis in infants born to women with clinical chorioamnionitis. J Perinat Med. 2018 Oct 25;46(8):926-933. doi: 10.1515/jpm-2017-0192.
19. https://neonatalsepsiscalculator.kaiserpermanente.org/InfectionProbabilityCalculator.aspx
20. Akangire G., Simpson E., Weiner J., Noel-MacDonnell J., Petrikin J., Sheehan M.Implementation of the Neonatal Sepsis Calculator in Early-Onset Sepsis and Maternal Chorioamnionitis. Adv Neonatal Care. 2020 Feb;20(1):25-32. doi: 10.1097/ANC.0000000000000668.
21. Berardi A., BuffagniA. M., Rossi C., Vaccina E., Cattelani C., Gambini L., Baccilieri F., Varioli F., Ferrari F.Serial physical examinations, asimple and reliable tool for managing neonates at risk for early-onset sepsis. World J Clin Pediatr. 2016 Nov 8;5(4):358-364. doi: 10.5409/wjcp.v5.i4.358.
22. Schlapbach L.J., Watson R. S., Sorce L. R., Argent A. C., Menon K., Hall M. W., Akech S., Albers D. J., Alpern E. R., Balamuth F., Bembea M., Biban P., Carrol E. D., Chiotos K., Chisti M. J., DeWitt P.E., Evans I., Flauzino de Oliveira C., HorvatC. M., InwaldD., Ishimine P., Jaramillo-Bustamante J.C., LevinM., Lodha R., MartinB., Nadel S., Nakagawa S., Peters M. J., Randolph A. G., Ranjit S., Rebull M. N., Russell S., Scott H. F., de Souza D. C., Tissieres P., WeissS. L., Wiens M. O., Wynn J. L., Kissoon N., Zimmerman J. J., Sanchez-Pinto L.N., BennettT. D.; Society of Critical Care Medicine Pediatric Sepsis Definition Task Force.International Consensus Criteria for Pediatric Sepsis and Septic Shock. JAMA. 2024 Feb 27;331(8):665-674. doi: 10.1001/jama.2024.0179.
23. Sanchez-Pinto L.N., Bennett T. D., DeWitt P.E., Russell S., Rebull M. N., Martin B., Akech S., AlbersD. J., AlpernE. R., Balamuth F., Bembea M., ChistiM. J., EvansI., HorvatC. M., Jaramillo-Bustamante J.C., Kissoon N., Menon K., ScottH. F., WeissS. L., Wiens M. O., Zimmerman J. J., Argent A. C., SorceL. R., Schlapbach L. J., WatsonR. S.; Society of Critical Care Medicine Pediatric Sepsis Definition Task Force; BibanP., Carrol E., ChiotosK., Flauzino De Oliveira C., HallM. W., InwaldD., Ishimine P., Levin M., Lodha R., Nadel S., NakagawaS., PetersM. J., RandolphA. G., Ranjit S., SouzaD. C., Tissieres P., WynnJ. L.Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock. JAMA. 2024 Feb 27;331(8):675-686. doi: 10.1001/jama.2024.0196.
24. Uzark K., King E., Cripe L. et al. Health-related quality of life in children and adolescents with Duchenne muscular dystrophy. Pediatrics. 2012 Dec;130(6): e1559-66. doi: 10.1542/peds.2012-0858.
25. Jackson G.L., Engle W. D., Sendelbach D. M., Vedro D. A., Josey S., Vinson J., Bryant C., Hahn G., RosenfeldC. R.Are complete blood cell counts useful in the evaluation of asymptomatic neonates exposed to suspected chorioamnionitis? Pediatrics. 2004 May;113(5):1173-80. doi: 10.1542/peds.113.5.1173.
26. Silveira R.C., ProcianoyR. S.Evaluation of interleukin-6, tumour necrosis factor-alpha and interleukin-1beta for early diagnosis of neonatal sepsis. Acta Paediatr. 1999 Jun;88(6):647-50. doi: 10.1080/08035259950169314.
27. Newman T.B., Puopolo K. M., Wi S., Draper D., Escobar G. J.Interpreting complete blood counts soon after birth in newborns at risk for sepsis. Pediatrics. 2010 Nov;126(5):903-9. doi: 10.1542/peds.2010-0935.
28. Hornik C.P., Benjamin D. K., Becker K. C., Benjamin D. K.Jr, Li J., Clark R. H., Cohen-Wolkowiez M., Smith P. B. Use of the complete blood cell count in early-onset neonatal sepsis. Pediatr Infect DisJ. 2012 Aug;31(8):799-802. doi: 10.1097/INF.0b013e318256905c.
29. Antonakos N., Tsaganos T., OberleV., TsangarisI., Lada M., PistikiA., Machairas N., Souli M., Bauer M., Giamarellos-Bourboulis E. J. Decreased cytokine production by mononuclear cells after severe gram-negative infections: early clinical signs and association with final outcome. Crit Care. 2017 Mar 9;21(1):48. doi: 10.1186/s13054-017-1625-1.
30. Doellner H., ArntzenK. J., HaereidP. E., Aag S., Austgulen R.Interleukin-6 concentrations in neonates evaluated for sepsis. J Pediatr. 1998 Feb;132(2):295-9. doi: 10.1016/s0022-3476(98)70448-2.
31. Downes K.J., FitzgeraldJ. C., WeissS. L.Utility of Procalcitonin as aBiomarker for Sepsis in Children. J Clin Microbiol. 2020 Jun 24;58(7): e01851-19. doi: 10.1128/JCM.01851-19.
32. Poggi C., Lucenteforte E., Petri D., De Masi S., Dani C.Presepsin for the Diagnosis of Neonatal Early-Onset Sepsis: ASystematic Review and Meta-analysis. JAMA Pediatr. 2022 Aug 1;176(8):750-758. doi: 10.1001/jamapediatrics.2022.1647.
33. Fleiss N., Schwabenbauer K., RandisT. M., PolinR. A.What’s new in the management of neonatal early-onset sepsis? Arch Dis Child Fetal Neonatal Ed. 2023 Jan;108(1):10-14. doi: 10.1136/archdischild-2021-323532.
34. Korang S.K., Safi S., Nava C., Gordon A., Gupta M., GreisenG., Lausten-Thomsen U., JakobsenJ. C.Antibiotic regimens for early-onset neonatal sepsis. Cochrane Database Syst Rev. 2021 May 17;5(5): CD013837. doi: 10.1002/14651858.CD013837.pub2.
35. Klein Klouwenberg P. M., Cremer O. L., van Vught L. A., Ong D. S., Frencken J. F., Schultz M. J., Bonten M. J., van der Poll T. Likelihood of infection in patients with presumed sepsis at the time of intensive care unit admission: acohort study. Crit Care. 2015 Sep7;19(1):319. doi: 10.1186/s13054-015-1035-1.
36. Ting J.Y., Synnes A., Roberts A., Deshpandey A., Dow K., YoonE. W., LeeK. S., Dobson S., LeeS. K., ShahP. S.; Canadian Neonatal Network Investigators. Association Between Antibiotic Use and Neonatal Mortality and Morbidities in Very Low-Birth-Weight Infants Without Culture-Proven Sepsis or Necrotizing Enterocolitis. JAMA Pediatr. 2016 Dec 1;170(12):1181-1187. doi: 10.1001/jamapediatrics.2016.2132.
37. Fouhy F., GuinaneC. M., Hussey S., Wall R., RyanC. A., DempseyE. M., Murphy B., RossR. P., FitzgeraldG. F., StantonC., CotterP. D. High-throughput sequencing reveals the incomplete, short-term recovery of infant gut microbiota following parenteral antibiotic treatment with ampicillin and gentamicin. Antimicrob Agents Chemother. 2012 Nov;56(11):5811-20. doi: 10.1128/AAC.00789-12.
38. Gyllensvärd J., Studahl M., Gustavsson L., Hentz E., Åkesson K., LiH., Norman M., Elfvin A.; SWENAB Study Group. Antibiotic Use in Late Preterm and Full-Term Newborns. JAMA Netw Open. 2024 Mar 4;7(3): e243362. doi: 10.1001/jamanetworkopen.2024.3362.
39. Chowdhary G., Dutta S., Narang A.Randomized controlled trial of 7-Day vs. 14-Day antibiotics for neonatal sepsis. J Trop Pediatr. 2006 Dec;52(6):427-32. doi: 10.1093/tropej/fml054.
40. McCandless S. E.Answering aQuestion Older Than Most Pediatricians: What to Do About Duarte Variant Galactosemia. Pediatrics. 2019 Jan;143(1): e20183292. doi: 10.1542/peds.2018-3292.
41. van den Anker J., Allegaert K.Rational Use of Antibiotics in Neonates: Still in Search of Tailored Tools. Healthcare (Basel). 2019 Feb 16;7(1):28. doi: 10.3390/healthcare7010028.
42. Gathwala G., Sindwani A., Singh J., Choudhry O., Chaudhary U. Ten days vs. 14 days antibiotic therapy in culture-proven neonatal sepsis. J Trop Pediatr. 2010 Dec;56(6):433-5. doi: 10.1093/tropej/fmq012.
43. Liem T.B.Y., Slob E. M.A., Termote J. U.M., Wolfs T. F.W., Egberts A. C.G., Rademaker C. M.A. Comparison of antibiotic dosing recommendations for neonatal sepsis from established reference sources.Int J Clin Pharm. 2018 Apr;40(2):436-443. doi: 10.1007/s11096-018-0589-9.
44. Dewez J.E., ChellaniH. K., Halim A., Van Den Broek N.Simplified antibiotic regimens for neonatal sepsis - AFRINEST(1). Lancet. 2015. doi: 10.1016/S0140-6736(15)00330-X
45. Martin A., Pappas A., Lulic-Botica M., Natarajan G.Impact of ‘targeted’ fluconazole prophylaxis for preterm neonates: efficacy of ahighly selective approach? J Perinatol. 2012 Jan;32(1):21-6. doi: 10.1038/jp.2011.27.
46. Dong Y., Basmaci R., Titomanlio L., Sun B., MercierJ. C.Neonatal sepsis: within and beyond China. Chin Med J (Engl). 2020 Sep 20;133(18):2219-2228. doi: 10.1097/CM9.0000000000000935.
47. Cotten C. M.Adverse consequences of neonatal antibiotic exposure. Curr Opin Pediatr. 2016 Apr;28(2):141-9. doi: 10.1097/MOP.0000000000000338.
48. Mukhopadhyay S., WadeK. C., PuopoloK. M.Drugs for the Prevention and Treatment of Sepsis in the Newborn. Clin Perinatol. 2019 Jun;46(2):327-347. doi: 10.1016/j.clp.2019.02.012.
49. Murray C.J.L., IkutaK. S., Sharara F. et al. Global burden of bacterial antimicrobial resistance in 2019: asystematic analysis. Lancet. 2022;399:629-655. doi: 10.1016/S0140-6736(21)02724-0.
50. Jackson C., Hsia Y., Basmaci R., Bielicki J., HeathP. T., VersportenA., Goossens H., Sharland M.Global Divergence From World Health Organization Treatment Guidelines for Neonatal and Pediatric Sepsis. Pediatr Infect Dis J. 2019 Nov;38(11):1104-1106. doi: 10.1097/INF.0000000000002433.
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For citations:
Lavrentyev S.N., Petrova A.S., Lyulka T.S., Loshkova E.V. Antimicrobial therapy in newborns: from theory to practice. Archives of Pediatrics and Pediatric Surgery. 2024;2(2):80-90. (In Russ.) https://doi.org/10.31146/2949-4664-apps-2-2-80-90
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