本文发表在 rolia.net 枫下论坛What Investigations should be Perfomed:
Full blood count.
Differential white cell count [Normal WBC 10-30,000 x 109/L] and percentage left shift [immature neutrophils/total neutrophil count].
If >20% this is moderately predictive of sepsis.
A low WCC especially with neutropenia is also suspicious of sepsis.
Blood cultures.
CXR
A C-Reactive Protein may be indicated.
On occasion skin/wound swabs and gastric aspirate [at birth only].
CSF may be needed in some cases - discuss with specialist.
The following investigations may need to be considered depending on the organism isolated.
Late onset sepsis: In addition to the above consider
Blood culture taken through central line.
Lumbar puncture and CSF for microbiology/biochemistry.
Urine by suprapubic aspirate [preferable] or catheter.
Antibiotic Use in Suspected Sepsis
First five days.
After first five days.
Start amoxycillin and gentamicin for all VLBW neonates and any infant who
Appears septic or is sicker than would be usually anticipated.
Has any vascular catheter [UVC/UAC, percutaneous long lines or surgically placed central venous lines]
Start amoxycillin and cefoxitin in all other babies
Start flucloxacillin and amikacin in all babies
Almost all Coag negative Staph is sensitive to Amikacin but resistant to gentamicin.
Flucloxacillin being used at present because of an increased number of Staph aureus isolates within the unit
Add amoxycillin if specific cover for Enterococci, Strep fecaelis [suspected NEC], Listeria or Group B Strep is needed.
Review clinical progress and microbiology results at 48 hours.
If cultures negative consider stopping therapy.
Cultures positive/sepsis very likely or confirmed continue therapy.
Add metronidazole if suspicion of anaerobic infection.
Consider vancomycin for coagulase negative staphylococci sepsis, especially if infant unwell or central line infection with line staying in. Discuss with specialist first.
Change to cefotaxime if neonatal meningitis. Discuss with specialist first.更多精彩文章及讨论，请光临枫下论坛 rolia.net
Full blood count.
Differential white cell count [Normal WBC 10-30,000 x 109/L] and percentage left shift [immature neutrophils/total neutrophil count].
If >20% this is moderately predictive of sepsis.
A low WCC especially with neutropenia is also suspicious of sepsis.
Blood cultures.
CXR
A C-Reactive Protein may be indicated.
On occasion skin/wound swabs and gastric aspirate [at birth only].
CSF may be needed in some cases - discuss with specialist.
The following investigations may need to be considered depending on the organism isolated.
Late onset sepsis: In addition to the above consider
Blood culture taken through central line.
Lumbar puncture and CSF for microbiology/biochemistry.
Urine by suprapubic aspirate [preferable] or catheter.
Antibiotic Use in Suspected Sepsis
First five days.
After first five days.
Start amoxycillin and gentamicin for all VLBW neonates and any infant who
Appears septic or is sicker than would be usually anticipated.
Has any vascular catheter [UVC/UAC, percutaneous long lines or surgically placed central venous lines]
Start amoxycillin and cefoxitin in all other babies
Start flucloxacillin and amikacin in all babies
Almost all Coag negative Staph is sensitive to Amikacin but resistant to gentamicin.
Flucloxacillin being used at present because of an increased number of Staph aureus isolates within the unit
Add amoxycillin if specific cover for Enterococci, Strep fecaelis [suspected NEC], Listeria or Group B Strep is needed.
Review clinical progress and microbiology results at 48 hours.
If cultures negative consider stopping therapy.
Cultures positive/sepsis very likely or confirmed continue therapy.
Add metronidazole if suspicion of anaerobic infection.
Consider vancomycin for coagulase negative staphylococci sepsis, especially if infant unwell or central line infection with line staying in. Discuss with specialist first.
Change to cefotaxime if neonatal meningitis. Discuss with specialist first.更多精彩文章及讨论，请光临枫下论坛 rolia.net