Neonatal sepsis Tx

[EazyE1907]

what is the distinguishing criteria in neonatal sepsis Treatment

i got a uworld question that has the answer as LP before Abx tx

then another question that says pretty much Abx Tx beefore doing LP

is it due to the age of the patient? sort of confused on this one. thanks!

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[Phloston]

what is the distinguishing criteria in neonatal sepsis Treatment

i got a uworld question that has the answer as LP before Abx tx

then another question that says pretty much Abx Tx beefore doing LP

is it due to the age of the patient? sort of confused on this one. thanks!

I'm not an expert on this but I had thought it's generally you do blood cultures before Abx, but Abx before LP. If you suspect a CNS infection/meningitis, it's urgent to give Abx to lower mortality. And in real life this makes sense. You would get IV access pretty much right away on a sick patient, and you'd be able to draw the bloods right there before putting anything in (e.g., fluids, Abx). But yeah, as far as I'm aware, you never delay Abx if you have reason to suspect CNS infection/meningitis.

 

[Thatsmyspot]

what is the distinguishing criteria in neonatal sepsis Treatment

i got a uworld question that has the answer as LP before Abx tx

then another question that says pretty much Abx Tx beefore doing LP

is it due to the age of the patient? sort of confused on this one. thanks!

I tried searching for the questions by adding neonatal sepsis but no luck. Would you mind posting the question IDs?

 

[EazyE1907]

I'm not an expert on this but I had thought it's generally you do blood cultures before Abx, but Abx before LP. If you suspect a CNS infection/meningitis, it's urgent to give Abx to lower mortality. And in real life this makes sense. You would get IV access pretty much right away on a sick patient, and you'd be able to draw the bloods right there before putting anything in (e.g., fluids, Abx). But yeah, as far as I'm aware, you never delay Abx if you have reason to suspect CNS infection/meningitis.

Hey phloston, thanks for taking the time to respond.

I read a little more about it on uworld and basically it boils down to this

when oyu have a pt with suspected sepsis, who is STABLE you want to do a LP before Abx tx. the reason behind this is that Abx tx can sterilize the CSF and skew the definitive diagnosis of the septic event

On the other hand, when you have a pt presenting with sepsis like symptoms and is also UNSTABLE (ie status epilepticus, shock, etc) you want to give Abx tx before doing an LP

These questions were out of Uworld and both were worded based upon if the patient was STABLE or UNSTABLE. So the tx options change with status of pt for sepsis.

And Yes, you always do blood cultures 1st in both cases. That never changes

 

[EazyE1907]

I tried searching for the questions by adding neonatal sepsis but no luck. Would you mind posting the question IDs?

3633 and 2428

 

[Phloston]

Hey phloston, thanks for taking the time to respond.

I read a little more about it on uworld and basically it boils down to this

when oyu have a pt with suspected sepsis, who is STABLE you want to do a LP before Abx tx. the reason behind this is that Abx tx can sterilize the CSF and skew the definitive diagnosis of the septic event

On the other hand, when you have a pt presenting with sepsis like symptoms and is also UNSTABLE (ie status epilepticus, shock, etc) you want to give Abx tx before doing an LP

These questions were out of Uworld and both were worded based upon if the patient was STABLE or UNSTABLE. So the tx options change with status of pt for sepsis.

And Yes, you always do blood cultures 1st in both cases. That never changes

From UpToDate: http://www.uptodate.com.ezproxy.library.uq.edu.au/contents/image?imageKey=ID/50114&topicKey=ID/1290&rank=1~150&source=see_link&search=Initial+therapy+and+prognosis+of+bacterial+meningitis+in+adults

According to UTD it's based on whether you do a CT or not. So you insert cannula, draw bloods, then give Abx, then do CT, then do LP if warranted; OR insert cannula, draw bloods, don't do CT but do LP, then give Abx.

Essentially the point is to avoid delay in giving Abx at all costs. But if a CT is warranted because of seizure, papilledema, etc., that consumes the time one could ordinarily spend doing an LP before the Abx, so instead the Abx would have to be given first in that case.