Use of the “Sepsis Risk Calculator” in Belgian Newborns: A Retrospective Cohort Study

Abstract

Background: Prevention of early-onset neonatal sepsis (EONS) is a frequent reason why many newborns receive unnecessary antibiotics. The Sepsis Risk Calculator (SRC) was developed by the Kaiser Permanente Institute as a multivariate risk assessment of EONS, aiming to reduce laboratory testing and empiric neonatal antibiotic therapy. Our objective was to assess the potential of the SRC in reducing antibiotic use in our setting. Methods: Late preterm and term newborns who received antibiotics from 2019 to 2020 in a tertiary Belgian hospital were included. Newborn-specific data were collected and entered into the online SRC, retrospectively calculating a sepsis risk score and providing recommendations for antibiotic administration. False-positive indications for treatment by the SRC were estimated based on previously published data. Antibiotic therapy rates according to the SRC recommendations were compared to the actual rate of antibiotic therapy. Results: Of 5891 births, 414 newborns received antibiotics and were eligible for this study, representing a rate of 7.6% of newborns receiving antibiotics following our current guidelines. The SRC would have recommended antibiotic administration for 2.7%, reducing antibiotic therapy by 64.5%. Of 5 possible cases of EONS, 3 would have received antibiotics in the first 24 hours according to the SRC. Conclusions: In this Belgian cohort, use of the SRC has the potential to significantly decrease by 64.5% the newborns that receive antibiotics. This reduction would primarily concern asymptomatic newborns. If use of the SRC was to be implemented in Belgian maternities, strict clinical surveillance practices should be ensured.

An Overview of Antibiotic Therapy for Early- and Late-Onset Neonatal Sepsis: Current Strategies and Future Prospects

“…The pathogens most frequently isolated in high-income countries are GBS (decreasing thanks to progress in the control of maternal infections) and Escherichia coli [ 50 , 51 ]. Instead, in LMICs, these were the first-place Gram-negative bacteria Enterobacteriaceae (i.e., Klebsiella ) and Gram-positive bacteria such as Staphylococcus aureus and CoNS [ 52 ]. However, in both areas, the increase in AMR represents an emerging crucial problem [ 53 ].…”

“…Overall, the available data highlight that AMR surveillance specific to each geographical region, a significant global commitment to accessible and effective antimicrobials for high-risk newborns and antibiotic stewardship programs for neonatal sepsis are essential [ 52 ].…”