Impact of the use of an early neonatal sepsis calculator
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Keywords
Neonatal Sepsis, Anti-Bacterial Agents, Infant, Newborn
Abstract
Background: Early onset neonatal sepsis (EOS) is a public health problem; antibiotic treatment is often unnecessary and can increase morbimortality. EOS risk calculator are available that allows limiting the use of antibiotics.
Objective: To compare the patterns of antibiotic use and hospitalization time in infant newborns (NB) ≥ 34 weeks of gestational age (GA) in a historical cohort attended from November 2017 to April 2018 vs. a prospective cohort from November 2018 to April 2019, before and after implementing the use of an EOS risk calculator, respectively.
Material and methods: Ambispective, observational, longitudinal, analytical study in infants NB ≥ 34 GA attended before and after implementing the use of an EOS risk calculator. The patterns of antibiotic´s use were compared. Simple frequencies and proportions, means and standard deviations or medians with ranges, Mann-Whitney U Test and Chi square test with SPSS V. 20.0 statistical package were used; considering significant values of p < 0.05.
Results: Thirty patients were included, 15 NB for each period, the gestational age average was 36.8 ± 2.3 GA. there was no statistically significant difference in the frequency of diagnosis of EOS with blood culture or days of hospital stay. Antibiotics were beginning in all the infants attended before the implementation of the EOS risk calculator, unlike 46.7% of the infants after its implementation (p = 0.001).
Conclusions: The EOS risk calculator is an easy tool to use, and demonstrated to be useful in decreasing unnecessary use of antibiotics.
References
Van Herk W, Stocker M, Van Rossum AM. Recognizing early onset neonatal sepsis: an essential step in appropriate antimicrobial use. J Infect. 2016;72(Supplement):S77-82. doi: 10.1016/j.jinf.2016.04.026
Ozkan H, Cetinkaya M, Koksal N, Celebi S, Hacimustafaouglu M. Culture-proven neonatal sepsis in preterm infants in a neonatal intensive care unit over a 7-year period: Coagulase-negative Staphylococcus as the predominant pathogen. Pediatr Int. 2014;56(1):60-6. doi: 10.1111/ped.12218
Klingenberg C, Kornelisse RF, Buonocore G, Maier RF, Stocker M. Culture-Negative Early-Onset Neonatal Sepsis - At the Crossroad Between Efficient Sepsis Care and Antimicrobial Stewardship. Front Pediatr. 2018;6:285. doi: 10.3389/fped.2018.00285
Schulman J, Dimand RJ, Lee HC, Duenas GV, Bennett MV, Gould JB. Neonatal intensive care unit antibiotic use. Pediatrics. 2015;135(5):826-33. doi: 10.1542/peds.2014-3409.
Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet. 2017;390(10104):1770-1780. doi: 10.1016/S0140-6736(17)31002-4.
Polin RA, Committee on Fetus and Newborn. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics. 2012;129(5):1006-1015. doi: 10.1542/peds.2012-0541
Gilfillan M, Bhandari V. Biomarkers for the diagnosis of neonatal sepsis and necrotizing enterocolitis: Clinical practice guidelines. Early Hum Dev. 2017;105:25-33. doi: 10.1016/j.earlhumdev.2016.12.002
Bedford-Russell AR, Kumar R. Early onset neonatal sepsis: diagnostic dilemmas and practical management. Arch Dis Child Fetal Neonatal Ed. 2015;100(4):F350-F354. doi: 10.1136/archdischild-2014-306193
Cotton CM. Antibiotic Stewardship Reassessment of Guidelines for Management of Neonatal Sepsis. Clin Perinatol. 2015;42(1):195-206. doi: 10.1016/j.clp.2014.10.007
Kiser C, Nawab U, McKenna K, Aghai ZH. Role of Guidelines on Length of Therapy in Chorioamnionitis and Neonatal Sepsis. Pediatrics. 2014;133(6):992-8. doi: 10.1542/peds.2013-2927
Randis TM, Murguia RM, Myatt L, Tita ATN, Leveno KJ, Reddy UM, et al. Incidence of early-onset sepsis in infants born to women with clinical chorioamnionitis. J Perinat Med. 2018;46(8):926-933. doi: 10.1515/jpm-2017-0192
Jan AI, Ramanathan R, Cayabyab R. Chorioamnionitis and management of Asymptomatic Infants ≥ 35 weeks without empiric antibiotics. Pediatrics. 2017;140(1):e20162744. doi: 10.1542/peds.2016-2744
Puopolo KM, Draper D, Wi S, Newman TB, Zupancic J, Lieberman E, et al. Estimating the Probability of Neonatal Early-Onset Infection on the Basis of Maternal Risk Factors. Pediatrics. 2011;128(5):e1155-e1163. doi: 10.1542/peds.2010-3464
Leonardi BM, Binder M, Griswold KJ, Yalcinkaya GF, Walsh MC. Utilization of a Neonatal Early-Onset Sepsis Calculator to Guide Initial Newborn Management. Pediatr Qual Saf. 2019;4(5):e214. doi: 10.1097/pq9.0000000000000214
Kuzniewicz MW, Walsh EM, Li S, Fischer A, Escobar GJ. Development and Implementation of an Early-Onset Sepsis Calculator to Guide Antibiotic Management in Late Preterm and Term Neonates. Jt Comm J Qual Patient Saf. 2016;42(5):232-9. doi: 10.1016/s1553-7250(16)42030-1
Puopolo KM, Benitz WE, Zaoutis TE, COMMITTEE ON FETUS AND NEWBORN, COMMITTEE ON INFECTIOUS DISEASES. Management of Neonates Born at ≥35 0/7 Weeks’ Gestation With Suspected or Proven Early-Onset Bacterial Sepsis. Pediatrics. 2018;142(6):e20182894
Escobar GJ, Puopolo KM, Wi S, Turk BJ, Kuzniewicz MW, Walsh EM, et al. Stratification of Risk of Early-Onset Sepsis in Newborns 34 Weeks’ Gestation. Pediatrics. 2014;133(1):30-6. doi: 10.1542/peds.2013-1689
Warren S, Garcia M, Hankins C. Impact of neonatal early-onset sepsis calculator on antibiotic use within two tertiary healthcare centers. J Perinatol. 2017;37(4):394-7. doi: 10.1038/jp.2016.236
Procianoy RS, Silveira RC. The challenges of neonatal sepsis management. J Pediatr. 2020;96(S1):80-6. doi: 10.1016/j.jped.2019.10.004
Achten NB, Dorigo-Zetsma JW, van der Linden PD, Van Brakel M, Plötz FB. Sepsis calculator implementation reduces empiric antibiotics for suspected early-onset sepsis. Eur J Pediatr. 2018;177(5):741-6. doi: 10.1007/s00431-018-3113-2
Dhudasia MB, Mukhopadhyay S, Puopolo KM. Implementation of the Sepsis Risk Calculator at an Academic Birth Hospital. Hosp Pediatr. 2018;8(5):243-50. doi: 10.1542/hpeds.2017-0180
Achten NB, Klingenberg C, Benitz WE, Stocker M, Schlapbach LJ, Giannoni E, et al. Association of Use of the Neonatal Early-Onset Sepsis Calculator With Reduction in Antibiotic Therapy and Safety: A Systematic Review and Meta-analysis. JAMA Pediatr. 2019;173(11):1032-40. doi: 10.1001/jamapediatrics.2019.2825.
Strunk T, Buchiboyina A, Sharp M, Nathan E, Doherty D, Patole S: Implementation of the Neonatal Sepsis Calculator in an Australian Tertiary Perinatal Centre. Neonatology. 2018;113(4):379-382. doi: 10.1159/000487298
Morris R, Jones S, Banerjee S, Collinson A, Hagan H, Walsh H, et al. Comparison of the management recommendations of the Kaiser Permanente neonatal early-onset sepsis risk calculator (SRC) with NICE guideline CG149 in infants ≥34 weeks’ gestation who developed early onset sepsis. Arch Dis Child Fetal Neonatal Ed. 2020;105:F581-F586.
Carvajal EF, Rivas FM. Usar una calculadora de sepsis neonatal evitaría abusar de la antibioticoterapia. Evid Pediatr 2018;14(3):1-3. Disponible en: https://evidenciasenpediatria.es/files/41-13406-RUTA/33_AVC_Neonatal.pdf. Fecha de consulta: 09 de marzo del 2021.
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