Goldberg et al reported a decision tree for identifying a neonate with suspected late-onset sepsis for whom antibiotics can be discontinued after a 24 hour reassessment. The authors are from multiple institutions in Israel and Hospital for Sick Children in Toronto.
Patient selection: neonate started on antibiotics for possible late-onset sepsis
Time of assessment: 24 hour after initial work-up
Predictors of sepsis:
(1) sick-appearance
(2) serum CRP > 0.75 mg/dL
(3) neutrophil to lymphocyte ratio (NLR) > 1.5
(4) positive blood culture
Sick Appearance
Positive Culture
Serum CRP
NLR
Percent Septic
yes
NA
NA
NA
91%
NA
yes
NA
NA
91%
no
no
CRP > 0.75
NA
43%
no
no
NA
> 1.5
43%
no
no
<= 0.75
<= 1.5
0%
Antibiotics can be discontinued if the patient is not sick appearing, blood cultures are negative, and the 2 laboratory tests are normal.
Performance:
• The area under the ROC curve is 0.94.
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