In 2013 German infection surveillance guidelines recommended weekly colonization screening for multidrug-resistant (MDRO) or highly epidemic organisms for neonatal intensive care units (NICUs) and extended hygiene measures based on screening results. It remains a matter of debate whether screening is worth the effort. We therefore aimed to evaluate sepsis related outcomes before and after the guideline update. The German Neonatal Network (GNN) is a prospective cohort study including data from extremely preterm infants between 22 + 0 and 28 + 6 gestational weeks born in 62 German level III NICUs. Infants treated after guideline update (n = 8.903) had a lower mortality (12.5% vs. 13.8%, p = 0.036), reduced rates for clinical sepsis (31.4 vs. 42.8%, p < 0.001) and culture-proven sepsis (14.4% vs. 16.5%, p = 0.003) as compared to infants treated before update (n = 3.920). In a multivariate logistic regression analysis, nine pathogens of culture-proven sepsis were associated with sepsis-related death, e.g. Pseudomonas aeruginosa [OR 59 (19–180), p < 0.001)]. However, the guideline update had no significant effect on pathogen-specific case fatality, total sepsis-related mortality and culture-proven sepsis rates with MDRO. While the exposure of GNN infants to cefotaxime declined over time (31.1 vs. 40.1%, p < 0.001), the treatment rate with meropenem was increased (31.6 vs. 26.3%, p < 0.001). The introduction of weekly screening and extended hygiene measures is associated with reduced sepsis rates, but has no effects on sepsis-related mortality and sepsis with screening-relevant pathogens. The high exposure rate to meropenem should be a target of antibiotic stewardship programs.

中文翻译：

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引入多重耐药菌定植筛查后，极低胎龄新生儿的败血症相关死亡率。

2013 年，德国感染监测指南建议每周对新生儿重症监护病房 (NICU) 的耐多药 (MDRO) 或高流行病菌进行定植筛查，并根据筛查结果采取扩大卫生措施。筛查是否值得付出努力仍然是一个有争议的问题。因此，我们旨在评估指南更新前后的败血症相关结果。德国新生儿网络 (GNN) 是一项前瞻性队列研究，包括来自 62 个德国 III 级新生儿重症监护病房中出生的 22 + 0 至 28 + 6 孕周的极早产儿的数据。指南更新后接受治疗的婴儿 (n = 8.903) 的死亡率较低（12.5% 对 13.8%，p = 0.036），临床脓毒症发生率降低（31.4 对 42.8%，p < 0.001）和经培养证实的脓毒症（14.4） % 与 16.5%，p = 0。003) 与更新前接受治疗的婴儿相比 (n = 3.920)。在多变量逻辑回归分析中，经培养证实的败血症的九种病原体与败血症相关的死亡有关，例如铜绿假单胞菌 [OR 59 (19–180), p < 0.001)]。然而，指南更新对特定病原体的病死率、与败血症相关的总死亡率和经培养证明的 MDRO 败血症率没有显着影响。虽然 GNN 婴儿对头孢噻肟的暴露随时间下降（31.1 对 40.1%，p < 0.001），但美罗培南的治疗率增加（31.6 对 26.3%，p < 0.001）。每周筛查和扩大卫生措施的引入与脓毒症发病率降低有关，但对脓毒症相关死亡率和筛查相关病原体的脓毒症没有影响。