POTENTIAL BENEFIT FROM THE IMPLEMENTATION OF THE KAISER PERMANENTE NEONATAL EARLY-ONSET SEPSIS CALCULATOR ON CLINICAL MANAGEMENT OF NEONATES WITH PRESUMED SEPSIS
Kopsidas I, Molocha NM, Kourkouni E, Coffin S, Gkentzi D, Chorianopoulou E, Dimitriou G, Kapetanaki A, Karavana G, Lithoxopoulou M, Polychronaki M, Roilides E, Triantafyllidou P, Triantafyllou C, Tsopela GC, Tsouvala E, Tsolia MN, Zaoutis T, Spyridis N; PHiG Investigators: Vassiliki Papaevangelou, Asimina Tsintoni, Vasiliki Soubasi-Griva, Marianna Skordala-Riti, Maria Theodoraki.
Eur J Pediatr., 2021 Oct, DOI: https://doi.org/10.1007/s00431-021-04282-x
Aim: To assess the potential benefit from the implementation of the Kaiser Permanente early-onset sepsis calculator (EOS-C), in terms of antibiotic use and requested laboratory tests, in a network of neonatal intensive care units (NICUs) in Greece, and to determine the incidence of early-onset sepsis (EOS) in Greek NICUs, a prospective surveillance study was conducted in 7 NICUs between April 2018 and June 2019.
Methods: Data were collected for all newborns ≥ 34 weeks’ gestation receiving empiric antibiotic therapy within the first 3 days of life. The number of live births and positive blood or cerebrospinal fluid cultures within the first 3 days of life were used for calculation of EOS incidence. Evaluation of possible impact of implementing the calculator was done by comparing the clinicians’ recorded management to the calculator’s suggested course of action.
Results: The unit-specific incidence of culture-proven EOS ranged between 0 and 2.99/1000 live births. The weighted incidence rate for all 7 units was 1.8/1000 live births. Management of EOS guided by the calculator could lead to a reduction of empiric antibiotic initiation up to 100% for the group of “well-appearing” neonates and 86% for “equivocal,” lowering exposure to antibiotics by 4.2 and 3.8 days per neonate, respectively. Laboratory tests for blood cultures drawn could be reduced by up to 100% and 68%, respectively. Sensitivity of the EOS-C in identifying neonates with positive blood cultures was high.
Conclusion: Management strategies based on the Kaiser Permanente neonatal sepsis calculator may significantly reduce antibiotic exposure, invasive diagnostic procedures, and hospitalizations in late preterm and term neonates.