Milstone AM, Elward A, Song X, Zerr DM, Orscheln R, Speck K, Obeng D, Reich NG, Coffin SE, Perl TM et al: Daily chlorhexidine bathing to reduce bacteraemia in critically ill children: A multicentre, cluster-randomised, crossover trial. Lancet 2013(0). Nearly 5000 Children more than 2 months old who were admitted to the PICU for more than 2 days were randomized to either get a bath with chlorhexidine every day (or being wiped all over with a chlorhexidine cloth) or control. Actually it was the ICUs that were randomized and had periods with and without chlorhexidine. There was an almost significant reduction in sepsis with the ITT analysis, and a just significant reduction with the ‘actually treated as they were supposed to be according to the way they were randomized’ analysis. An accompanying editorial (Toltzis P, Goldmann D: Rethinking infection prevention research. Lancet 2013(0). Suggests that such trial should be done only when all the quality control initiatives have reduced central line infection rates to minimal levels. I am not so sure; despite the best efforts using evidence based interventions currently there are still substantial variations between hospitals. We need further evidence based interventions and good trials to show us what to do next.
Chong E, Reynolds J, Shaw J, Forur L, Delmore P, Uner H, Bloom BT, Gordon P: Results of a two-center, before and after study of piperacillin-tazobactam versus ampicillin and gentamicin as empiric therapy for suspected sepsis at birth in neonates <1500g. J Perinatol 2013. I think this is a Very Bad Idea. Giving broad spectrum antibiotics that are not indicated to infants with negative cultures for reasons that are questionable (one of the reasons given for changing empiric therapy of early onset sepsis was an increase in resistant organisms causing late onset sepsis). They didn’t show an adverse effects, but just wait a while! We should be focussing on giving fewer antibiotics, with narrower, appropriate, spectra, for shorter periods. And not giving them at all unless there is an indication.
Berardi A, Rossi C, Lugli L, Creti R, Bacchi Reggiani ML, Lanari M, Memo L, Pedna MF, Venturelli C, Perrone E et al: Group b streptococcus late-onset disease: 2003-2010. Pediatrics 2013, 131(2):e361-e368. An epidemiologic study from Italy of late onset GBS. Being preterm increased the risk, as we already know, there is a high incidence of serious brain lesions associated with late onset disease. If the mother had intrapartum antibiotics, the disease tended to be milder, and to present later.