medigraphic.com
ISSN 2007-8013 (Print)
Órgano oficial de la Universidad Autónoma de Sinaloa

2026, Number 1

<< Back Next >>

Rev Med UAS 2026; 16 (1)

Empirical antibiotic use in neonates with suspected early-onset sepsis: a retrospective analysis at a secondary-level hospital

García-Cárdenas CÁ, Martínez-Félix NS, López-Ríos EG, Cabanillas-Ayón M, Pérez-García XH

Language: Spanish
References: 26
Page: 13-25
PDF size: 239.00 Kb.


ABSTRACT

Objective: To describe the empirical use of antibiotics in newborns (NB) with suspected early-onset neonatal sepsis (EONS) in a secondary-level hospital, considering clinical criteria and the results of biomarkers and blood cultures. Materials and methods: An observational, descriptive, and retrospective study conducted at the Hospital Civil de Culiacán, based on the review of medical records of neonates ≥34 weeks of gestational age hospitalized for suspected EONS between January 2011 and December 2020. Perinatal risk factors, C-reactive protein (CRP), procalcitonin (PCT) and blood culture results, antibiotic regimens, and treatment duration were analyzed. Results: A total of 593 newborns were included in the final analysis after applying the selection criteria. Of these, 99.8% (n=592) received empirical antibiotic therapy; however, only 3% (n=18) had a positive blood culture. PCT demonstrated 100% sensitivity and a 100% negative predictive value (NPV), but low specificity (27.3%). In 157 newborns with negative PCT, clinical signs and systemic inflammatory response (SIR) parameters were additionally evaluated. In this subgroup, 51.6% (n=81) showed no clinical manifestations compatible with sepsis, and 57 patients received antibiotic treatment despite the absence of clinical findings or alterations in CRP or blood cultures. Of the 593 newborns included, 93.7% (n=555) received standard empirical regimens, and 82.4% (n=488) received antibiotics for more than three days. Conclusions: There is a significant discrepancy between antibiotic initiation and clinical or microbiological evidence in suspected EOS. The systematic integration of biomarkers, risk factors, and clinical findings— aligned with national and international guidelines (CENETEC, SIBEN)—is essential to optimize management and avoid unnecessary treatments and their potential consequences.


REFERENCES

  1. Sola A, Mir R, Lemus L, Fariña D, Ortiz J, etal. Suspected neonatal sepsis: tenth clinicalconsensus of the Ibero-American Society ofNeonatology (SIBEN). NeoReviews. 2020;21(8):e505–e534. DOI:10.1542/neo.21-8-e505

  2. Centro Nacional de Excelencia Tecnológicaen Salud (CENETEC). Guía de práctica clínica:Sepsis neonatal temprana. México:CENETEC; 2019. Disponible en:https://www.cenetec-difusion.com/CMGPC/GPC-SS-283-19/ER.pdf

  3. Pérez RO, Lona JC, Quiles M, Verdugo MÁ,Ascencio EP, Benítez EA. Sepsis neonataltemprana, incidencia y factores de riesgoasociados en un hospital público del occidentede México. Rev Chil Infectol.2015;32(4):447-52. doi:10.4067/S0716-10182015000500003.

  4. World Health Organization. WHO recommendationson newborn health: guidelinesapproved by the WHO Guidelines ReviewCommittee. Geneva: WHO; 2017. Availablefrom: https://www.who.int/publications/i/item/WHO-MCA-17.07

  5. Puopolo KM, Lynfield R, Cummings JJ,Hand I, Adams-Chapman I, Poindexter B, etal. Management of infants at risk for GroupB Streptococcal disease. Pediatrics.2019;144(2):e20191881. DOI:10.1542/peds.2019-1881

  6. Fajardo Dubón GE, Flores Zelaya RE, CárcamosPortillo GA. Caracterización generalde sepsis neonatal temprana. Rev FacCienc Med. 2017;14(2):28-35. Availablefrom: https://pesquisa.bvsalud.org/portal/resource/pt/biblio-882650

  7. Cortés JS, Fernández Cruz LX, BeltránZúñiga E, Narváez CF, Fonseca-BecerraCE. Sepsis neonatal: aspectos fisiopatológicosy biomarcadores. Med UIS.2019;32(3):35-47.doi:10.18273/revmed.v32n3-2019005

  8. Geraerds AJLM, van Herk W, Stocker M, ElHelou S, Dutta S, Fontana MS, et al. Costimpact of procalcitonin-guided decision makingon duration of antibiotic therapy for suspectedearly-onset sepsis in neonates. CritCare. 2021;25:367. DOI:10.1186/s13054-021-03789-x

  9. Puello Ávila AC, Cataño Villegas AE. Utilidadde la proteína C-reactiva en la sepsisneonatal temprana. Rev Chil Infectol.2021;38(2):169-77. doi:10.4067/S0716-

  10. 1018202100020016910. Gong CL, Dasgupta-Tsinikas S, ZangwillKM, Bolaris M, Hay JW. Early onset sepsiscalculator-based management of newbornsexposed to maternal intrapartum fever: acost-benefit analysis. J Perinatol.2019;39(4):571-80. doi:10.1038/s41372-019-0316-y

  11. Achten NB, Visser DH, Tromp E, Groot W,van Goudoever JB, Plötz FB. Early onsetsepsis calculator implementation is associatedwith reduced healthcare utilization andfinancial costs in late preterm and term newborns.Eur J Pediatr. 2020;179(5):727-34.doi:10.1007/s00431-019-03510-9

  12. Achten NB, Dorigo-Zetsma JW, van der LindenPD, van Brakel M, Plötz FB. Sepsis calculatorimplementation reduces empiric antibioticsfor suspected early-onset sepsis. EurJ Pediatr. 2018;177(5):741-6.doi:10.1007/s00431-018-3113-2.

  13. Good PI, Hooven TA. Evaluating newbornsat risk for early-onset sepsis. Pediatr ClinNorth Am. 2019;66(2):321-31.doi:10.1016/j.pcl.2018.12.003.

  14. Milliken S, Allen RM, Lamont RF. The role ofantimicrobial treatment during pregnancy onthe neonatal gut microbiome and the developmentof atopy, asthma, allergy and obesityin childhood. Expert Opin Drug Saf.2019;18(3):173-85.doi:10.1080/14740338.2019.1579795

  15. Guan G, Joshi NS, Frymoyer A, AchepohlGD, Dang R, Taylor NK, et al. Resource utilizationand costs associated with approachesto identify infants with early-onsetsepsis. MDM Policy Pract.2024;9(1):23814683231226129.doi:10.1177/23814683231226129

  16. Puopolo KM, Benitz WE, Zaoutis TE. Managementof neonates born at ≥35 0/7 weeks'gestation with suspected or proven early-onsetbacterial sepsis. Pediatrics.2018;142(6):e20182894.doi:10.1542/peds.2018-2894

  17. Ahmed SA, Shah M, Ameley A, Mosuka E,Ericksen K. Culture negative sepsis in neonatein a level III NICU of a community hospitalin Brooklyn New York. Int J ContempPediatr. 2025;12(2):154-8.doi:10.18203/2349-3291.ijcp20250079.

  18. Schulman J, Benitz WE, Profit J, Lee HC,Dueñas G, Bennett MV, et al. Newborn antibioticexposures and association with provenbloodstream infection. Pediatrics.2019;144(5):e20191105.doi:10.1542/peds.2019-1105

  19. Montaner Ramón A, Castilla Fernández Y,Frick MA, Camba Longueira F, CéspedesDomínguez MC, Ribes Bautista C, et al.¿Cómo evaluar la sepsis neonatal de inicioprecoz? Estudio comparativo de tres estrategiasde detección. An Pediatr (Barc).

  20. 2023;98(2):92-8.doi:10.1016/j.anpedi.2022.10.00820. Ostia-Garza PJ, Salzar-Espino B. Frecuenciade factores relacionados con sepsis neonatal.Perinatol Reprod Hum. 2021;35(1):3-9. doi:10.24875/per.19000059.

  21. Tibanquiza Arreaga LDP, Rodriguez AvilésDA, Barrera Rivera MK, Cedeño CaballeroJV. Factores de riesgo y prevención de sepsisneonatal temprana. Rev Cient Mundo InvestigConoc. 2019;3(3 Esp):513–528.doi:10.26820/recimundo/3.(3.Esp).noviembre.2019.513-528.Available from: http://recimundo.com/index.php/es/article/view/620

  22. Hospital Infantil de México Federico Gómez.Sepsis bacteriana del recién nacido, no especificada.Guías clínicas del Departamentode Neonatología. México: HIMFG; 2011.Available from: http://himfg.com.mx/descargas/documentos/planeacion/guiasclinicasHIM/Gmobimortalidad.pdf

  23. Cardetti M, Rodríguez S, Sola A. Uso (yabuso) de antibióticos en la medicina perinatal.An Pediatr (Barc). 2020;93(3):207.e1–207.e7. doi:10.1016/j.anpedi.2020.06.010

  24. Short MA. Guide to a systematic physical assessmentin the infant with suspected infectionand/or sepsis. Adv Neonatal Care.2004;4(3):141–57.doi:10.1016/j.adnc.2004.04.007

  25. Sánchez-Garduño J. Procalcitonin and neonatalsepsis: clinical and laboratory aspects.Rev Mex Patol Clin Med Lab.2016;63(3):148–154. Available from:https://www.medigraphic.com/pdfs/patol/pt-2016/pt163f.pdf

  26. Chiesa C, Panero A, Rossi N, Stegagno M,De Giusti M, Osborn JF, Pacifico L. Reliabilityof procalcitonin concentrations for the diagnosisof sepsis in critically ill neonates.Clin Infect Dis. 1998 Mar;26(3):664–72.doi:10.1086/514576.




2020     |     www.medigraphic.com