C-reactive protein- and clinical symptoms-guided strategy in term neonates with early-onset sepsis reduced antibiotic use and hospital stay: a quality improvement initiative

Abstract

Background Early-onset sepsis (EOS) is a potentially life-threatening complication of birth. Clinical symptoms are often unspecific and biomarkers have low predictive values for EOS. Therefore, clinical suspicion often leads to antibiotic therapy in neonates with a negative blood culture. In the study we evaluated if a quality improvement initiative could reduce unwarranted antibiotic use in a safe way in term neonates with culture-negative sepsis. Methods The quality improvement initiative included new treatment guidelines and were introduced on 11 June 2018. The guidelines included C-reactive protein- and clinical symptoms-guided decision-making and shorter intravenous antibiotic therapy. All term neonates treated for EOS at Ryhov Hospital, Jönköping, Sweden were studied before (period 1: 2016–2017) and after the introduction of the new guidelines (period 2: 11 June 2018 to 30 Sept 2019). Laboratory and clinical data were analysed. Results There were 7618 term neonates in period 1 and 5005 term neonates in period 2. We identified 140 (1.8%) EOS in period 1 and 97 (1.9%) EOS in period 2. During period 1 and 2, there were 61 (61/140, 44%) and 59 (59/97, 61%) EOS neonates, respectively, who met the criteria for shorter antibiotic treatment. The number of positive blood cultures were seven (0.92/1000 live births) and five (1.0/1000 live births) in period 1 and 2. The median C-reactive protein were 52 mg/L (37–62) in period 1 and 42 mg/L (31–56) in period 2 in the group who met the criteria of the guidelines. The duration of antibiotic therapy (Median: seven vs. five days, p < 0.001) and hospital stay (Median: seven vs. five days, p < 0.001) as well as healthcare costs (decreased by €122,000/year) was reduced in the group who met the criteria after the introduction of the guidelines. Conclusion C-reactive protein- and clinical symptoms-guided decision-making for EOS significantly decreased the duration of antibiotic therapy and hospital stay, and hence reduced healthcare costs, with no reinfection in a cohort of term infants. Trial registration Trial registration number: ISRCTN29535824. Date of registration: 28 May 2020. Retrospectively registered.

Antibiotic Use in Late Preterm and Full-Term Newborns

“…There are different strategies to reduce neonatal antibiotic use . One of the most popular strategies in recent years is using the EOS calculator .…”

“…Antibiotic exposure in early life influences the developing microbiome and may be associated with an increased risk of asthma, allergy, overweight, diabetes, and inflammatory bowel disease later in life . Moreover, neonatal antibiotic use is associated with longer hospital stay and increased health care costs . Therefore, it is paramount to reduce unwarranted antibiotic use in newborns.…”

Role of C-reactive protein and gastric aspirate polymorphs in early onset neonatal sepsis

“…They concluded that CRP and clinical symptoms guided decision-making for early onset neonatal sepsis significantly decreased the duration of antibiotic therapy and hospital stay and hence reduced healthcare cost. 24 GA cellularity correlates directly with the occurrence of clinical infection with sensitivity of 75% and specificity of 70%. CRP with GA was found to be the best combination with sensitivity of 80% and specificity of 70%.…”

Is it safe for neonates with probable bacterial infection to be treated with oral antibiotics in high-income countries?

“…Gyllensvärd et al published their quality improvement report from a single hospital in Sweden 4. Their unit introduced a new guideline for intravenous antibiotics to oral amoxicillin switch for culture-negative EOI in term babies.…”