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Abstract

Objective: Neonatal sepsis is a leading cause of mortality and morbidity in neonatal units. Neonates are often exposed to prolonged periods of antibiotics, leading to adverse outcomes. This study aimed to assess the time to positivity (TTP) in early-onset neonatal sepsis (EONS) and late-onset neonatal sepsis (LONS) and its impact on the duration of empirical antibiotics. Methods: A retrospective cohort review was conducted from January 1, 2021, to December 31, 2023, at Al Qassimi Women’s and Children’s Hospital, Sharjah, United Arab Emirates. Neonates admitted to the neonatal intensive care unit (NICU) with positive blood cultures and confirmed EONS or LONS were included. Contaminants and Candida species were analyzed separately due to their distinct growth kinetics. An independent t-test was employed to compare the TTP between contaminants and true pathogens. A multivariate linear regression model was developed to investigate predictors of TTP. Results: We included 138 neonatal sepsis cases with positive blood cultures. Of these, 36 cases of EONS (26%) and 102 cases of LONS (74%) were identified. The TTP for contaminants (mean = 75.8 h) and Candida (mean = 68.5 h) were significantly longer compared to other pathogens (p < 0.001). In EONS, 100% (36/36) yielded positive bacterial growth within 36 hours. For LONS, 100% (102/102) yielded positive bacterial growth within 48 hours. Only 5% of bacteria (5 coagulase-negative staphylococci) yielded positive growth between 36 and 48 hours. Multivariate linear regression analysis showed longer TTP was associated with gram-positive pathogens and antibiotic pretreatment (p < 0.05). Neonatal risk factors and laboratory markers did not significantly affect TTP. Conclusion: In our cohort, a 36-hour incubation period was adequate to detect pathogenic bacteria in EONS, while LONS required 48 hours. TTP remained an intrinsic characteristic of bacterial species and was unaffected in the absence of antibiotic pretreatment.

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