Culture negative sepsis in neonate in a level III NICU of a community hospital in Brooklyn New York

Background: Neonates often diagnosed with possible sepsis without any evidence of bacterial cause, known as “culture negative sepsis (CnS)”. Most data on neonatal sepsis focuses on culture proven sepsis but large number of neonates receives antibiotic for CnS and its epidemiological data is not accurately represented. Studies suggest that its incidence exceeds incidence of proven sepsis by 16 folds in United states and 50-fold in resource limited settings. According to recent estimates CnS contributes to 20% antibiotic usage in Neonatal intensive care units (NICUs). It is linked to adverse neurodevelopmental outcomes. We aim to identify the incidence and frequency of CnS in a community NICU. Methods: It is a retrospective observational study between November 2023 to March 2024 in a level III NICU. Neonates admitted during 1st January 2023 till 30th June 2023 and required antibiotic were included. IRB approval was obtained. Data collected for gestational age, gender, diagnosis, blood culture, indication, type, number of days of antibiotic, length of stay, invasive device and duration, birth weight, blood culture and comorbid condition. Data was analyzed using SPSS 22.0. Frequencies and percentages calculated and Pearson Chi-square used to assess correlations, p<0.05 considered statistically significant. Results: The 95 neonates enrolled. Incidence of CNS was 64%. The 15% patients require invasive devices. Most common indication for antibiotic use was clinical SIRS (75%). The 49% of babies had comorbidities and most common comorbidity was prematurity (47%). Conclusions: CnS has high incidence in community hospital NICU’s then reported in literature.