Sepsis calculator implementation reduces empiric antibiotics for suspected early-onset sepsis

Abstract

Pragmatic and feasible implementation of the sepsis calculator yields a 44% reduction of empirical use of antibiotics for EOS, without signs of delay or prolongation of treatment. These findings warrant a multicenter, nation-wide, randomized study evaluating systematic use of the sepsis calculator prediction model and its effects in clinical practice outside of the USA. What is known: • Significant overtreatment with antibiotics for suspected early-onset sepsis results in unnecessary costs, risks, and harms. • Implementation of the sepsis calculator in the USA has resulted in a significant decrease in empirical antibiotic treatment, without apparent adverse events. What is new: • Implementation of the sepsis calculator in daily clinical decision-making in a Dutch teaching hospital is feasible in conjunction with existing protocols, with high adherence. • Antibiotic therapy for suspected early-onset sepsis was reduced by 44% following implementation of the calculator.

Efficacy and safety of applying a neonatal early‐onset sepsis risk calculator in China

“…There is a need for a simple and efficient predictor for identifying non‐infected neonates in the first few hours of life, so they can be protected from unnecessary antibiotic exposure and from the spread of multidrug‐resistant organisms. The EOS risk calculator has already been used in practice in some neonatal centres in Western countries and has been validated as a tool to reduce unnecessary antibiotic exposure in previous studies …”

“…The EOS risk calculator has already been used in practice in some neonatal centres in Western countries and has been validated as a tool to reduce unnecessary antibiotic exposure in previous studies. [5][6][7] However, it is worth noting that there are limitations to applying the EOS risk calculator in China. First, it is still challenging for clinicians to recognise EOS early and begin treatment in symptomatic infected infants.…”

“…The EOS risk calculator, which was based on a retrospective study of 350 cases of EOS and 1063 controls at 14 hospitals between 1993 and 2007, aimed to combine maternal risk factors and neonatal clinical findings to predict risk of EOS . This risk stratification scheme put forward by investigators at Kaiser Permanente is being increasingly used by neonatologists to help with early diagnosis of EOS and to control unnecessary antibiotic use; so far, it has shown some efficiency in reducing the rate of antibiotic use without major adverse events in both retrospective and prospective studies . However, more safety data are needed, and data on its use in developing countries are lacking.…”

“…4 This risk stratification scheme put forward by investigators at Kaiser Permanente is being increasingly used by neonatologists to help with early diagnosis of EOS and to control unnecessary antibiotic use; so far, it has shown some efficiency in reducing the rate of antibiotic use without major adverse events in both retrospective and prospective studies. [5][6][7] However, more safety data are needed, and data on its use in developing countries are lacking. Before adopting this procedure in China, we wanted to test whether it would safely reduce the antibiotic use in our unit based on available historical data.…”

The microbiota–gut–brain axis: A promising avenue to foster healthy developmental outcomes

“…Finally, the use of preventive antibiotic treatment in the neonate may affect normal microbial colonization (see Neuman, Forsythe, Uzan, Avni, & Koren, for a review). Although more prospective multicentered research is warranted before modifying care protocols, a recent study found that the use of antibiotics in neonates with suspected early‐onset sepsis can be reduced by 44% through a change in medical practices (Achten, Dorigo‐Zetsma, van der Linden, van Brakel, & Plötz, ).…”