Interesting article: “Ending the Culture of Culture-Negative Sepsis in the Neonatal ICU” in the October 2017 edition of Pediatrics (Volume 140, Number 4). Antibiotics are not without side effects, and we always think about them causing short term side effects, but according to this article, there is evidence that prolonged exposure can result in diseases such as obesity and atopy.
When there are short AND long term consequences at play, it gives more power to the antimicrobial stewardship viewpoint. Certainly antibiotic resistance is a major concern, especially on a population-level.
I remember when I worked in the UK, the lab would reject any blood culture that had insufficient quantity of blood in it. At the time, I would be drawing the blood culture samples myself, so I know it can sometimes be quite challenging to get the right amount.
This article highlights the importance of drawing 1mL of blood at minimum, and that they have excellent sensitivity and are the gold standard for diagnosing neonatal sepsis. We should learn to trust a negative blood culture, and treat no longer than 36-48h if culture returns negative and patient is clinically well.
Essentially, all efforts must be put forth in obtaining the correct amount of blood, which will also reduce the number of times repeated blood sampling is required (which is quite important in premature babies/LBW babies).
Great article, has impacted my practice!