{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T23:48:17Z","timestamp":1780444097437,"version":"3.54.1"},"reference-count":93,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,3,19]],"date-time":"2024-03-19T00:00:00Z","timestamp":1710806400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>The fear of missing sepsis episodes in neonates frequently leads to indiscriminate use of antibiotics, and prescription program optimization is suggested for reducing this inappropriate usage. While different authors have studied how to reduce antibiotic overprescription in the case of early onset sepsis episodes, with different approaches being available, less is known about late-onset sepsis episodes. Biomarkers (such as C-reactive protein, procalcitonin, interleukin-6 and 8, and presepsin) can play a crucial role in the prompt diagnosis of late-onset sepsis, but their role in antimicrobial stewardship should be further studied, given that different factors can influence their levels and newborns can be subjected to prolonged therapy if their levels are expected to return to zero. To date, procalcitonin has the best evidence of performance in this sense, as extrapolated from research on early onset cases, but more studies and protocols for biomarker-guided antibiotic stewardship are needed. Blood cultures (BCs) are considered the gold standard for the diagnosis of sepsis: positive BC rates in neonatal sepsis workups have been reported as low, implying that the majority of treated neonates may receive unneeded drugs. New identification methods can increase the accuracy of BCs and guide antibiotic de-escalation. To date, after 36\u201348 h, if BCs are negative and the baby is clinically stable, antibiotics should be stopped. In this narrative review, we provide a summary of current knowledge on the optimum approach to reduce antibiotic pressure in late-onset sepsis in neonates.<\/jats:p>","DOI":"10.3390\/tropicalmed9030063","type":"journal-article","created":{"date-parts":[[2024,3,19]],"date-time":"2024-03-19T04:36:31Z","timestamp":1710822991000},"page":"63","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Stop in Time: How to Reduce Unnecessary Antibiotics in Newborns with Late-Onset Sepsis in Neonatal Intensive Care"],"prefix":"10.3390","volume":"9","author":[{"given":"Domenico Umberto","family":"De Rose","sequence":"first","affiliation":[{"name":"Neonatal Intensive Care Unit, \u201cBambino Ges\u00f9\u201d Children\u2019s Hospital IRCCS, 00165 Rome, Italy"},{"name":"PhD Course in Microbiology, Immunology, Infectious Diseases and Transplants (MIMIT), Faculty of Medicine and Surgery, \u201cTor Vergata\u201d University of Rome, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Paola","family":"Ronchetti","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, \u201cBambino Ges\u00f9\u201d Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Santisi","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, \u201cBambino Ges\u00f9\u201d Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Bernaschi","sequence":"additional","affiliation":[{"name":"Microbiology Unit, \u201cBambino Ges\u00f9\u201d Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3090-5949","authenticated-orcid":false,"given":"Ludovica","family":"Martini","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, \u201cBambino Ges\u00f9\u201d Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5931-8679","authenticated-orcid":false,"given":"Ottavia","family":"Porzio","sequence":"additional","affiliation":[{"name":"Clinical Laboratory Unit, \u201cBambino Ges\u00f9\u201d Children\u2019s Hospital IRCCS, 00165 Rome, Italy"},{"name":"Department of Experimental Medicine, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1260-6427","authenticated-orcid":false,"given":"Andrea","family":"Dotta","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, \u201cBambino Ges\u00f9\u201d Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9820-6557","authenticated-orcid":false,"given":"Cinzia","family":"Auriti","sequence":"additional","affiliation":[{"name":"Casa di Cura Villa Margherita, 00161 Rome, Italy"},{"name":"Faculty of Medicine and Surgery, Saint Camillus International University of Health Sciences, 00131 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2423","DOI":"10.1038\/s41467-023-38156-7","article-title":"Less Is More: Antibiotics at the Beginning of Life","volume":"14","author":"Stocker","year":"2023","journal-title":"Nat. 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