Neonatal Nosocomial Sepsis Care Guideline
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Neonatal Nosocomial Sepsis Care Guideline Recommendations/Considerations Patients at risk for sepsis include prematurity, <1500 grams birth weight, recent antibiotic use, presence of central venous catheters and/ or ventilator. ID consult when: 1) blood culture + for Candida spp, 2) need for antibiotics extends beyond the recommended duration, 3) need for broader coverage resulting in use of Meropenem, 4) meningitis is suspected (optional) Consider addition of fluconazole if < 750 gm BW, received previous broad-spectrum antibiotic & has new onset thrombocytopenia (refer to Neonatal Antifungal Guideline). Duration of treatment of bloodstream infection should be 10-14 days from 1 st neg culture. Central vascular catheter care should be performed per CHOC protocol (Mosby – CVAD) Observe aseptic technique during central catheter changes Inclusion Criteria: > 7 days old Hospitalized in the NICU/CVICU w/ new onset signs and symptoms of infection Assessment Vital signs, cardiac/respiratory/neuro status Hemodynamic status Presence of central catheters (inspect sites) and/or ventilator Assess need for central catheters daily Continued Considerations Adjust antibiotics per culture results and response to therapy If on gentamicin beyond 48-72 hrs, monitor renal function & serum concentrations Remove central venous catheters (when possible) if infection related DC antibiotics if culture neg at 48- 72 hrs & based on clinical status Reassess the appropriateness of Care Guidelines as condition changes and 24 hrs after admission. This guideline is a tool to aid clinical decision making. It is not a standard of care. The physician should deviate from the guideline when clinical judgment so indicates. Approved Care Guidelines Committee 4-23-09, revised 3-20-13 Parent Education Handout – hand hygiene Keep parents updated on infant’s condition Guide parents to appropriate support services Interventions Hemodynamic support as needed Labs: CBC w/ manual diff & platelets, CRP, BMP, culture blood (central & peripheral), urine, CSF Consider ID consult Cefepime (dose based on post conceptual & chronological age & weight – refer to order set) AND Vancomycin x 48 -72 hrs (dose based on post conceptual & chronological age & recent SCr – refer to order set) Hemodynamic instability, respiratory decompensation, poor perfusion Oxacillin (dose based on post conceptual & chronological age and weight – refer to order set) AND Gentamicin (dose based on post conceptual & chronological age & recent SCr – refer to order set) No gentamicin levels during 1 st 48-72 hrs unless clinically indicated Recommendations for culture confirmed infections: Staph aureus – use Oxacillin (preferable if susceptible) or Vancomycin Candida spp in blood – Refer to the Neontal antifungal Guideline and consult infectious Disease Specialist Yes No © 2013 Children’s Hospital of Orange County
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Transcript of Neonatal Nosocomial Sepsis Care Guideline
Neonatal Nosocomial Sepsis Care Guideline
Recommendations/Considerations
Patients at risk for sepsis include prematurity, <1500 grams birth weight, recent antibiotic use, presence of central venous catheters and/ or ventilator.ID consult when: 1) blood culture + for Candida spp, 2) need for antibiotics extends beyond the recommended duration, 3) need for broader coverage resulting in use of Meropenem, 4) meningitis is suspected (optional)Consider addition of fluconazole if < 750 gm BW, received previous broad-spectrum antibiotic & has new onset thrombocytopenia (refer to Neonatal Antifungal Guideline).Duration of treatment of bloodstream infection should be 10-14 days from 1st neg culture.Central vascular catheter care should be performed per CHOC protocol (Mosby – CVAD)Observe aseptic technique during central catheter changes
Inclusion Criteria: > 7 days oldHospitalized in the NICU/CVICU w/ new onset signs and symptoms of infection
AssessmentVital signs, cardiac/respiratory/neuro statusHemodynamic statusPresence of central catheters (inspect sites) and/or ventilatorAssess need for central catheters daily
Continued ConsiderationsAdjust antibiotics per culture results and response to therapyIf on gentamicin beyond 48-72 hrs, monitor renal function & serum concentrationsRemove central venous catheters (when possible) if infection relatedDC antibiotics if culture neg at 48-72 hrs & based on clinical status
Reassess the appropriateness of Care Guidelines as condition changes and 24 hrs after admission. This guideline is a tool to aid clinical decision making. It is not a standard of care. The physician should deviate from the guideline when clinical judgment so indicates.
Approved Care Guidelines Committee 4-23-09, revised 3-20-13
Parent EducationHandout – hand hygieneKeep parents updated on infant’s conditionGuide parents to appropriate support services
InterventionsHemodynamic support as neededLabs: CBC w/ manual diff & platelets, CRP, BMP, culture blood (central & peripheral), urine, CSFConsider ID consult
Cefepime (dose based on post conceptual & chronological age &
weight – refer to order set)
ANDVancomycin x 48-72 hrs (dose based on post conceptual & chronological age & recent
SCr – refer to order set)
Hemodynamic instability, respiratory
decompensation, poor perfusion
Oxacillin (dose based on post conceptual & chronological age and weight – refer to order set) ANDGentamicin (dose based on post conceptual & chronological age & recent SCr – refer to order set)No gentamicin levels during 1st
48-72 hrs unless clinically indicated
Recommendations for culture confirmed infections:
Staph aureus – use Oxacillin (preferable if susceptible) or VancomycinCandida spp in blood –Refer to the Neontal antifungal Guideline and consult infectious Disease Specialist
YesNo
© 2013 Children’s Hospital of Orange County
