Early-Onset Bugs and Drugs
What pathogen that causes early-onset sepsis should be screened for in pregnancy?
What is Group B Streptococcus?
A 5-day-old neonate in the NICU begins to present with suspected sepsis. What antibiotics would you recommend to empirically treat this patient?
What are aminoglycosides (typically gentamicin) and vancomycin?
- Could use nafcillin or oxacillin as alternatives to vancomycin
What is the antiviral of choice for a neonate with late-onset sepsis who is at risk or tests positive for HSV?
What is Acyclovir?
How does sepsis develop in a newborn?
What is bacteria being transmitted vertically from the mother before or during delivery?
Why should ceftriaxone be avoided in a newborn with early-onset sepsis?
What is the risk for kernicterus?
What viral infection is of the highest concern in neonates with late-onset sepsis?
What is the most common pathogen that causes fungal infections in newborn sepsis?
What is Candida albicans?
- Accounts for 10% of nosocomial infections
What is the best way to prevent neonatal sepsis?
What are maternal IV antibiotics for prevention of GBS?
What labs can be assessed in order to diagnose a newborn with sepsis?
What is WBC count, immature to total neutrophil count (I:T ratio) and blood cultures?
What are the most common pathogens that cause early-onset sepsis?
What is E. coli, Group B Streptococcus, Enterococcus and Listeria?
What monitoring should be performed when utilizing antibiotics for late-onset sepsis?
What are same monitoring parameters for early-onset plus AUC:MIC or trough monitoring for Vancomycin?
- AUC:MIC may be preferred because trough may take much longer
What antifungals are recommended for the treatment of fungal infections in a newborn with sepsis?
What are fluconazole, conventional amphotericin b or micafungin?
What is an acceptable alternative for sepsis prophylaxis in a mom who is allergic to penicillins?
What is Clindamycin?
What are common risk factors for sepsis in a newborn?
What are prolonged rupture of membranes (≥ 18 hours), maternal age ≤ 19 years old, low Apgar scores (0-3 at 5 minutes), positive or unknown Group B colonization status, prenatal antibiotic exposure or signs/symptoms of chorioamnionitis?
What monitoring should be performed when utilizing antibiotics for early-onset sepsis?
What are renal function and gentamicin trough?
What are the most common pathogens that cause late-onset sepsis?
What is coagulase-negative Staphylococcus (Staphylococcus epidermidis) and gram negative bacteria?
Aside from treatment of fungal infections, what other indication can fluconazole be used for in newborns with sepsis?
What is prophylaxis when utilizing a 3rd generation cephalosporin?
- Recommended for routine use for NICU's with an invasive fungal infection rate > 10%
What microbial diseases are recommended to be screened for during pregnancy?
What are Group B Streptococcus, HIV, Hepatitis B and C, Chlamydia, Gonorrhea and Syphilis?
When should maternal testing for Group B Streptococcus take place?
What is 35-37 weeks?
What antibiotics may be utilized for meningitis coverage in early-onset sepsis?
What is the biggest risk factor for late-onset sepsis?
What is prematurity?
- Risk increases with decreased GA
What is the recommended treatment if a patient develops an invasive fungal infection while on prophylaxis with fluconazole?
What is escalate therapy to amphotericin B?
- Note: Only conventional amphotericin B should be used in neonatal patients
At what age can a newborn develop early-onset sepsis?
- However, this can occur within the first 7 days of life for a term newborn outside of the NICU.
Why should routine use of 3rd generation cephalosporins be avoided in pre-term neonates?
What is risk of invasive fungal infections?