Point of care v/s central lab automated blood culture system in decreasing antibiotic usage in NICU: A randomized controlled trial.

Abstract

BackgroundAntibiotic usage is rampant in NICUs. The time of stoppage of antibiotics depends predominantly on clinical condition of the neonate and final blood culture report. Delay in availability of report due to lab logistics might delay the stoppage of antibiotic. Hence, we hypothesized that having a point of care BACTEC system in NICU premises might reduce the delay, allowing earlier stoppage of antibiotics when no more warranted.ObjectiveTo compare the antibiotic usage (number of antibiotic doses) in neonates warranting antibiotics for suspected sepsis (both early onset and late onset sepsis) when the point of care blood culture system (BACTEC) has been used as compared to the central lab system.Design, Setting, and ParticipantsThis open labelled randomized controlled trial was conducted in a tertiary care NICU from November 2021 to April 2023. Inborn neonates with suspected sepsis in whom antibiotics were considered first time were participants.InterventionsFirst blood cultures in neonates with suspected sepsis were placed in NICU BACTEC or sent to the central lab as per randomization.Main Outcome MeasuresBoth the groups were compared for number of antibiotic doses.Results268 eligible neonates were randomized, 132 in point of care and 136 in central lab arm. Median antibiotic doses in neonates with suspected sepsis were 13 (7,25) versus 12 (8,29) in NICU versus central lab BACTEC arm (p = 0.501). Antibiotics were stopped in ≤48 hours in 25% neonates and 19.9% in NICU and central lab BACTEC, respectively. The mean antibiotic doses of the neonates whose antibiotics were stopped before 48 hours is 5.6 +/- 0.9 versus 6.3 +/- 1.5 in NICU versus central lab BACTEC arm (p = 0.042). There was no significant difference in mortality, necrotizing enterocolitis (NEC), subsequent culture-positive sepsis, fungal sepsis, and duration of hospital stay in both groups. In the central lab group, the mean time taken for the final report to be uploaded was 131 +/- 43 hours.ConclusionsThere was no significant difference in number of antibiotic doses among NICU and central lab arms. However, antibiotics were stopped early (<48 hours) in more neonates when point of care BACTEC was used. Establishing the effect of point of care blood culture system in reducing antibiotic use requires further studies with a larger sample size.