Item 40. Early Sepsis and/or Meningitis (on or before Day 3)
Q: If a baby has a positive culture for Coagulase negative Staphylococci on day 1, 2, or 2 of life, does this qualify as Early Sepsis?
A: No, Coagulase Negative Staphylococci diagnosed on day 1, 2, or 3 of life , does not qualify as Early Sepsis because it is not included as a bacterial pathogen in Appendix C. Also, Coagulase Negative Staphylococci infections are not tracked in our system if they occur on or before day 3 of life.
Q: How should we test for early sepsis? Should we check for positive culture other than blood?
A: Early Bacterial Sepsis and/or Meningitis (on or before day 3) [EBSEPS]
Select Yes if a bacterial pathogen from the Bacterial Pathogens List (see next item) was recovered from a blood and/or cerebrospinal fluid culture obtained on day 1, 2, or 3 of life.
Select No if a bacterial pathogen from the Bacterial Pathogens List was not recovered from a blood culture or cerebrospinal fluid culture obtained on day 1, 2, or 3 of life, or if no blood or cerebrospinal fluid cultures were obtained on day 1, 2, or 3 of life.
Select Unknown if this information cannot be obtained.
Note:
- The date of birth counts as day 1 regardless of the time of birth. For an infant born at 11:59 PM on September 1, day 3 will be September 3rd.
- If an infant transports into your center, who is being treated for early bacterial sepsis because of a positive culture drawn at the referring hospital, this infant qualifies, even if a repeat culture drawn at your center is negative. However, if an infant transports into your center who was diagnosed with early sepsis but is no longer septic (due to treatment at the referring hospital), this infant does not qualify.
- The on-line form figures out the date of day 3 and displays it on the form based on the information entered for infant birth date.
Q: An infant is transferred from Hospital A to Hospital B. In Hospital A the baby shows positive for sepsis but negative in Hospital B. Which information should be put on the form?
A: Even though a negative blood culture was obtained after transfer to Hospital B, there is still a documented occurrence of a positive blood culture and/or cerebrospinal fluid obtained between Day 1-3 in Hospital A. If entering data for Hospital A, mark EBS here. If entering data for Hospital B, mark EBS elsewhere.
Q: Are infants with late sepsis (after 3 days) eligible into the database?
A: Small babies will automatically qualify regardless if they have late sepsis or not. Big babies would NOT qualify on this criterion alone.
Item 40-42 Post-Delivery Diagnoses and Interventions - Infections
Q: Need guidance. I have a patient (infant ID 02614) who was born with a congenital infection (Streptococcus Gallolyticus) but it's not one of the pathogens I can select and there's no other box for me to type in the pathogen. I don't want to select unknown because I obviously know what it is. Please advise.
A: No is the correct answer. That’s a common commensal, not a true pathogen.
Item 41a. Late Sepsis/Meningitis (After Day 3)
Q: What is considered Late Sepsis?
A: Late Sepsis is a positive blood culture that occurs ON or AFTER day 4. Indicate if infant had sepsis ON or AFTER Day 4 by answering each of the 3 parts of the question. If baby died or was discharged on day 1, 2, or 3 or if the infant was discharged prior to day 4, check "N/A".
Q: A 2-3 week old baby that developed clinical signs and symptoms of late onset infection including septic shock. Blood cultures were negative. The tracheal culture grew Staphylococcus aureus (methycilin resistant) and the pleural fluid grew Stapholococcus aureus (methycilin resistant). The clinical course was totally compatible with toxic shock syndrome with regional loss of tissue in a dermatone distribution that eventually required surgical interventions. In the absence of a positive blood culture for Staphylococcus aureus, would this infant qualify for late sepsis?
A: No, since the infant was diagnosed based on the pleural fluid and not blood or cerebrospinal fluid, the infant is not eligible.
Q: a 25-week premature infant is born with clinical signs of septic shock, DIC, thrombocytopenia, respiratory distress. Blood culture was negative, but the tracheal culture taken immediately after birth and before antibiotics was started grew Group B Streptococcus. In the absence of a positive culture for Group b Streptococcus, would this infant qualify for late sepsis?
A: No, this baby would not be included as septic because there are too many other possibilities, but this baby would still qualify as a Small Baby.