Table 2.

Strategies to Optimize Use of Antibiotics for Culture-negative sepsis among VLBW Infants

Sepsis Evaluation
Blood culture	1. Obtain minimum 1 mL blood per pediatric blood culture bottle 2. Consider 2 separate cultures to optimize identification of contaminant species after 72 hours of life
CSF culture	Strongly consider obtaining CSF culture prior to initiation of antibiotics for evaluations after 72 hours of life
Urine culture	1. Strongly consider urine culture in older VLBW infants without central lines 2. Obtain culture by sterile catheter or supra-pubic aspirate to minimize isolation of contaminant species
Non-bacterial cultures	1. Consider urine CMV testing for infants with BW <1000 grams fed mother’s own milk 2. Consider additional respiratory and gastrointestinal viral testing in site-specific appropriate seasons
Antibiotic Choice and Duration
Conduct annual review of unit-specific culture isolates and antibiotic susceptibility data to inform empiric antibiotic choice
Discontinue antibiotics when blood cultures are sterile by 36–48 hours incubation
If decision is made to empirically administer antibiotics for presumed and culture-negative infection (CNI):   1. Use patient-specific colonizing data to choose least broad-spectrum antibiotic   2. Set local guidelines for antibiotic duration for presumed and CNI   3. Ensure that the rationale, risks and benefits of antibiotic administration for presumed and CNI are discussed with all members of the clinical care team and with the infant’s parent(s) or guardians   4. Involve the stewardship team in decision making