A survey of antimicrobial therapy for culture-negative sepsis in pediatric congenital heart disease patients.

BACKGROUND

In pediatric sepsis, the source of infection remains unidentified in approximately 16% of cases, and causative microorganisms are not isolated in 35% of cases, potentially due to non-infectious etiologies or false-negative culture results. Although a 7- to 10-day antimicrobial regimen is commonly used for culture-negative sepsis (CNS), robust evidence supporting this practice is limited.

METHODS

This prospective cohort study included congenital heart disease patients aged <5 years who were admitted to a pediatric intensive care unit between April 2022 and March 2024, diagnosed with sepsis, and those who exhibited negative culture results, but received antimicrobial therapy for at least 7 days. Descriptive epidemiological analysis was conducted on antimicrobial use in the CNS and instances of antimicrobial re-administration within 1 month.

RESULTS

Sixteen cases were analyzed, with a median age of 1 month. Eleven patients (69%) had received prior antimicrobial therapy within 1 week, primarily for surgical prophylaxis. All blood cultures yielded negative results. Bacterial growth was identified in one urine culture and two sputum cultures; however, these were asymptomatic carriers. The most frequently administered empirical regimens were cefepime combined with vancomycin. Antimicrobial re-administration occurred in five cases (31%), with a median duration of 8 days, and were primarily attributed to device-related infections; however, one case was later diagnosed as mediastinitis. Four patients (25%) died within 1 month, with mortality attributed to underlying conditions, but not to infectious diseases.

CONCLUSION

A 7-day course of antimicrobials may be sufficient in CNS; however, vigilant monitoring for deep-seated infections is advised.