Journal de la grossesse et de la santé infantile

Abstrait

Contributions of Procalcitonin in the Treatment of Neonatal Late Onset Sepsis: A Prospective Observational Study

Aude du Mesniladelee, Valérie Champion, François Kieffer, Mohamed Ali Lachtar, Inès de Montgolfier, Laurence Foix l’Hélias and Delphine Mitanchez

Background: Duration of antibiotic treatment in neonatal late onset sepsis is empirical. Objectives: a) To study the evolution of procalcitonin during treatment of secondary sepsis in new-borns, b) To evaluate the reduction of antibiotic exposure using its serial measurements. Methods: This single-center prospective observational study was conducted in a level II neonatology unit in the Armand Trousseau Hospital in Paris, France. All neonates hospitalized in the unit between December 2011 and January 2013 with suspected infection after 5 days of life and serum procalcitonin concentration >0.6 μg/L were included. Serial procalcitonine, C-reactive protein and blood culture survey was performed during antimicrobial therapy. Antimicrobial therapy was administered for 10 days after the last positive blood culture. Results: 54 infective episodes were observed in 46 neonates, born at a mean term of 32 weeks (range: 26-40) and infected at mean age of 19 days (7-40). Staphylococci was found in 31 infective episodes (57.4%), other microorganisms in 12 (22.2%), and none bacteria in 11 episodes (20.4%). The main cause was central line infection (85.2%). On day 5, 80% of procalcitonin measurements were <0.6 μg/L compared to 60% of C-reactive protein <5 mg/L measurements. If antimicrobial therapy had been discontinued when serum procalcitonine level was <0.6 μg/L, or the decrease from the maximal procalcitonin level was at least 80%, the duration would have been 5 days shorter. Conclusion: The use of procalcitonine in neonatal late onset sepsis as a guide to duration of treatment may limit the prescription of antibiotics. This should be further examined in a controlled study