Barriers to Implementing NICE Guidelines for Early Onset Neonatal Infection – Cross-sectional Survey of Neonatal Blood Culture Reporting by UK Laboratories

Background: In 2012, the National Institute for Health and Care Excellence (NICE) published guidelines for managing early-onset neonatal infections. It recommended starting antibiotics early for neonates with suspected infection and to discontinue them at 36 hours if blood culture were negative, initial clinical suspicion wasn`t strong, clinical condition was reassuring and CRP was satisfactory.

Aims: To explore how neonatal blood cultures are reported by microbiology laboratories in the UK, to ascertain current practice and to facilitate better implementation of NICE guidelines.

Methods: Cross-sectional survey was conducted amongst biomedical scientists via telephone interview involving all 208 UK laboratories attached to hospitals providing neonatal services. Respondents were asked about awareness of NICE guidelines, if paediatric blood culture bottle were used, if tests were performed ‘on-site’ and whether there was a system for publishing results automatically out-of-hours including how positive/negative results were communicated.

Results: 198/208 (95.2%) of laboratories responded. 125 (63.1%) laboratories did blood culture analysis ‘on-site’. 6/125 biomedical scientists were not aware of the NICE guidelines and 5/125 centres used adult blood culture bottles. Communication to clinicians for negative cultures by 36-hours was available out-of-hours using an automated reporting system in 56/125 (44.8%). For positive blood culture a similar reporting system was available in 32/125 (25.6%) laboratories.

Conclusions: 55% laboratories were not reporting negative blood culture results out-of-hours while 74% laboratories depended on manual systems for positive results. Standardisation of blood culture reporting at 36 hours is essential for proper implementation of the NICE guidelines and better service delivery including improved antimicrobial stewardship.