Duration of empiric antibiotic coverage for ruling out early-onset sepsis in neonates

Early-onset neonatal sepsis (EOS) carries significant mortality, prompting the initiation of empiric antibiotics pending blood culture results, which increases neonatal antibiotic exposure. In 2022, our institution shortened antibiotic coverage of EOS rule-outs from 36 to 24 h. We evaluated the safety of this change and its impact on antibiotic use.

This single hospital retrospective cohort study (2018-2023) compared infants <72 h of life who underwent EOS evaluation under 36- vs. 24-h protocols. Demographics, causative organisms, time to positivity (TTP), and antibiotic utilization for EOS were compared.

Among 1491 blood cultures, 17 had positive cultures and all had a TTP < 24 h. Cohorts were clinically similar. Mean antibiotic days initiated in the first 72 h of life decreased from 1.8 to 1.5 following the protocol change (Standard Deviations 0.29 and 0.25).

Reducing antibiotic coverage from 36 to 24 h lowered antibiotic exposure without inappropriate discontinuation of antibiotics.