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Background  In 2013 German infection surveillance guidelines recommended weekly colonization screening for multidrug-resistant (MDRO) or highly epidemic organisms for neonatal intensive care units (NICUs) and extended hygiene measures based on screening results. It remains a matter of debate whether screening is worth the effort. We therefore aimed to evaluate sepsis related outcomes before and after the guideline update.    Methods  The German Neonatal Network (GNN) is a prospective cohort study including data from extremely preterm infants between 22 + 0 and 28 + 6 gestational weeks born in 62 German level III NICUs.    Results  Infants treated after guideline update ( n  = 8.903) had a lower mortality (12.5% vs. 13.8%,  p  = 0.036), reduced rates for clinical sepsis (31.4 vs. 42.8%,  p  <  0.001) and culture-proven sepsis (14.4% vs. 16.5%,  p  = 0.003) as compared to infants treated before update ( n  = 3.920). In a multivariate logistic regression analysis, nine pathogens of culture-proven sepsis were associated with sepsis-related death, e.g.  Pseudomonas aeruginosa  [OR 59 (19–180),  p  <  0.001)]. However, the guideline update had no significant effect on pathogen-specific case fatality, total sepsis-related mortality and culture-proven sepsis rates with MDRO. While the exposure of GNN infants to cefotaxime declined over time (31.1 vs. 40.1%,  p  <  0.001), the treatment rate with meropenem was increased (31.6 vs. 26.3%,  p  <  0.001).    Conclusions  The introduction of weekly screening and extended hygiene measures is associated with reduced sepsis rates, but has no effects on sepsis-related mortality and sepsis with screening-relevant pathogens. The high exposure rate to meropenem should be a target of antibiotic stewardship programs.

Sepsis related mortality of extremely low gestational age newborns after the introduction of colonization screening for multi-drug resistant organisms