A comparison between risk-factor guidance for neonatal early-onset sepsis and Kaiser Permanente sepsis risk calculator in a Greek cohort.
Antibiotics
Early-onset sepsis
Kaiser Permanente
Neonate
Journal
Early human development
ISSN: 1872-6232
Titre abrégé: Early Hum Dev
Pays: Ireland
ID NLM: 7708381
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
received:
26
11
2020
revised:
28
01
2021
accepted:
02
02
2021
pubmed:
20
2
2021
medline:
15
12
2021
entrez:
19
2
2021
Statut:
ppublish
Résumé
The management of neonates with early-onset sepsis (EOS) is based on maternal risk factors and infant clinical indications. An online sepsis risk calculator (SRC) has been established taking into consideration how clinical appearance modifies the initial risk for EOS. To compare our clinical practice based on risk-factor guidance with that projected through the application of the SRC. Retrospective cohort study. All neonates ≥34 weeks' gestation, during 01/2019-8/2020. The SRC was applied retrospectively to determine the recommendation. EOS was defined based on a positive blood or cerebrospinal fluid culture-proven infection within 72 h of age. Clinical sepsis was defined according to the European Medicine Agency criteria. Differences on antibiotic administration and management. Overall, 2084 infants were identified, of whom 150 (7%) received antibiotics. Of them, 34 infants were diagnosed with clinical sepsis, while one was diagnosed with culture positive-proven EOS. Applying SRC, 87 (4%) infants would have received antibiotics. Clinical sepsis was diagnosed in 29 infants, while one infant had culture positive-proven EOS. Sixty-seven of 150 (45%) infants that received antibiotics would not have been treated based on SRC; five infants that developed clinical sepsis would have been missed with SRC. A 99.7% agreement between both guidance was found regarding infants not indicated for antibiotics. SRC application led to an absolute reduction of antibiotic administration by 2.93% (95% CI 2.19-3.75), p < 0.0001. The adoption of SRC would have significantly reduced antibiotic usage; however, a significant portion of cases with clinical EOS would have been missed.
Sections du résumé
BACKGROUND
The management of neonates with early-onset sepsis (EOS) is based on maternal risk factors and infant clinical indications. An online sepsis risk calculator (SRC) has been established taking into consideration how clinical appearance modifies the initial risk for EOS.
AIMS
To compare our clinical practice based on risk-factor guidance with that projected through the application of the SRC.
STUDY DESIGN
Retrospective cohort study.
METHODS
All neonates ≥34 weeks' gestation, during 01/2019-8/2020. The SRC was applied retrospectively to determine the recommendation. EOS was defined based on a positive blood or cerebrospinal fluid culture-proven infection within 72 h of age. Clinical sepsis was defined according to the European Medicine Agency criteria.
OUTCOME MEASURES
Differences on antibiotic administration and management.
RESULTS
Overall, 2084 infants were identified, of whom 150 (7%) received antibiotics. Of them, 34 infants were diagnosed with clinical sepsis, while one was diagnosed with culture positive-proven EOS. Applying SRC, 87 (4%) infants would have received antibiotics. Clinical sepsis was diagnosed in 29 infants, while one infant had culture positive-proven EOS. Sixty-seven of 150 (45%) infants that received antibiotics would not have been treated based on SRC; five infants that developed clinical sepsis would have been missed with SRC. A 99.7% agreement between both guidance was found regarding infants not indicated for antibiotics. SRC application led to an absolute reduction of antibiotic administration by 2.93% (95% CI 2.19-3.75), p < 0.0001.
CONCLUSIONS
The adoption of SRC would have significantly reduced antibiotic usage; however, a significant portion of cases with clinical EOS would have been missed.
Identifiants
pubmed: 33607601
pii: S0378-3782(21)00028-1
doi: 10.1016/j.earlhumdev.2021.105331
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
105331Informations de copyright
Copyright © 2021 Elsevier B.V. All rights reserved.