Sepsis calculator implementation reduces empiric antibiotics for suspected early-onset sepsis
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Significant overtreatment with antibiotics for suspected early onset sepsis (EOS) constitutes a persisting clinical problem, generating unnecessary risks, harms, and costs for many newborns. We aimed to study feasibility and impact of a sepsis calculator to help guide antibiotic for suspected EOS in a European setting. In this single-center study, the sepsis calculator was implemented as an addition to and in accordance with existing protocols. One thousand eight hundred seventy-seven newborns ≥ 35 weeks of gestational age were prospectively evaluated; an analogous retrospective control group (n = 2076) was used for impact analysis. We found that empirical treatment with intravenous antibiotics for suspected EOS was reduced from 4.8 to 2.7% after sepsis calculator implementation (relative risk reduction 44% (95% confidence interval 21.4–59.5%)). No evidence for changes in time to treatment start, treatment duration, or proven sepsis rates was found. Adherence to sepsis calculator recommendation was 91%.
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.
KeywordsEarly-onset sepsis Antibiotic stewardship Neonatology Sepsis calculator
Group B streptococcus
We thank Sharon Tai for her help in data collection.
NBA performed data collection, data analysis, and writing of the manuscript. WD and PL assisted in data collection and reviewed the manuscript. MB co-designed the study, helped in data collection, and reviewed the manuscript. FP designed the study and supervised in data collection, data analysis, and writing of the manuscript.
Compliance with ethical statements
This article does not contain any studies with human participants or animals performed by any of the authors. The study was approved by the Scientific Review Committee of Tergooi Hospitals (study number 15.58; letter reference kV/15.69).
Conflict of interest
The authors declare that they have no conflict of interest.
The Scientific Review Committee of Tergooi Hospitals judged that the study did not fall under the Medical Research Involving Human Subjects Act, so that informed consent by patients and caregivers was not required.
- 1.Weston EJ, Pondo T, Lewis MM, Martell-Cleary P, Morin C, Jewell B, Daily P, Apostol M, Petit S, Farley M, Lynfield R, Reingold A, Hansen NI, Stoll BJ, Shane AJ, Zell E, Schrag SJ (2011) The burden of invasive early-onset neonatal sepsis in the United States, 2005–2008. Pediatr Infect Dis J 30:937–941. https://doi.org/10.1097/INF.0b013e318223bad2 CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Trijbels-Smeulders M, de Jonge GA, Pasker-de Jong PCM, Gerards LJ, Adriaanse AH, van Lingen RA, Kollée LAA (2007) Epidemiology of neonatal group B streptococcal disease in the Netherlands before and after introduction of guidelines for prevention. Arch Dis Child Fetal Neonatal Ed 92:F271–F276. https://doi.org/10.1136/adc.2005.088799 CrossRefPubMedPubMedCentralGoogle Scholar
- 5.National Collaborating Centre for Women’s and Children’s Health (UK) (2012) Antibiotics for early onset neonatal infection: antibiotics for the prevention and treatment of early-onset neonatal infection. In: Packham K (ed) NICE Clinical Guidelines, 149th ed. RCOG Press, LondonGoogle Scholar
- 16.NVOG (Nederlandse Vereniging voor Obstetrie en Gynaecologie), NVK (Nederlandse Vereniging Kindergeneeskunde) (2017) Preventie en behandeling van early-onset neonatale infecties (Adaptatie van de NICE-richtlijn). 1–94Google Scholar