Comparison of NICE Guideline CG149 and the Sepsis Risk Calculator for the Management of Early-Onset Sepsis on the Postnatal Ward

Abstract

<b><i>Introduction:</i></b> The NICE guideline CG149 has increased the number of well infants receiving antibiotics for suspected early-onset sepsis (EOS). The Kaiser Permanente sepsis risk calculator (SRC) has safely and dramatically reduced investigations and antibiotics for suspected EOS in the USA. This study evaluates the current management of suspected EOS against the NICE guideline CG149 and the SRC. <b><i>Methods:</i></b> This study is a prospective, multicentre, observational study across 13 neonatal units in London. Infants were born between June and August 2019 at ≥34 weeks gestation and commenced on antibiotics for suspected EOS and cared for on postnatal/transitional care wards. Data were prospectively recorded: risk factors, clinical indicators, investigations, and results. Outcome measures included the following: (1) incidence of EOS and (2) proportion of infants recommended for antibiotics by NICE versus theoretical application of SRC. <b><i>Results:</i></b> 1,066/8,856 (12%) infants on postnatal/transitional care wards received antibiotics, 7 of whom had a positive blood culture (group B <i>Streptococcus</i> = 6 and <i>Escherichia coli</i> = 1), making the EOS incidence 0.8/1,000 infants. Six hundred one infants had data for SRC analysis, which recommended “antibiotics” or “blood culture” for 130/601 (21.6%) infants using an EOS incidence of 0.5/1,000 versus 527/601 (87.7%) if NICE was applied. <b><i>Conclusions:</i></b> Currently, 12.0% of infants on postnatal/transitional care wards receive antibiotics for suspected EOS. The SRC could dramatically reduce antibiotic use, but further prospective studies are required to evaluate safety of SRC implementation.

Agreement between an Early-Onset Neonatal Sepsis Risk Calculator and the Colombian Clinical Practice Guideline in Three Tertiary-Care Centers in Bogotá, Colombia

“…Seven confirmed cases of EONS were reported in this period, all of which received a recommendation to start or consider antibiotics according to EOSCalc. However, one of these cases did not receive this recommendation according to the Colombian CPG, which might suggest that EOSCalc displays greater sensitivity for EONS 1,12,28,29 .…”

“…The results presented here should not be interpreted as a suggestion to disregard local guidelines or expert recommendations, which can help inform the decision-making process of physicians in high-risk clinical scenarios. Risk assessment calculators should simply be an additional tool to be used in clinical practice (1). A potential reduction in unnecessary antibiotic use could mitigate the effects of alterations in the intestinal microbiota, such as the development of chronic illnesses [8][9][10][11][12][13][14][15][16][17][18][20][21][22]34 .…”

“…Early-Onset Neonatal Sepsis (EONS) is a clinical condition responsible for a large number of hospital admissions worldwide 1 . The etiological organism most frequently reported is Streptococcus agalactiae, a member of the Group B Streptococci (GBS).…”

“…Both the United Kingdom's NICE guideline and the Colombian Early-Onset Neonatal Sepsis Clinical Practice Guidelines (CPG) discourage the use of risk assessment tools in managing EONS 5,6 . However, various studies have been carried out to evaluate the clinical, economic and social outcomes derived from using EOSCalc in different populations, with favorable results like reductions in the rates of NICU admissions, procedures and antibiotic use 1,[7][8][9][10][11][12][13][14][15][16][17][18][19] . Other studies highlight the concern that EOSCalc may miss EONS cases, leading to delays in diagnosis and negative outcomes 1,[19][20][21][22][23] .…”

Neonatal Early Onset Sepsis (EOS) Calculator plus Universal Serial Physical Examination (SPE): A Prospective Two-Step Implementation of a Neonatal EOS Prevention Protocol for Reduction of Sepsis Workup and Antibiotic Treatment

“…The combination of different risks and clinical statuses correspond to different workup and treatment protocols [ 14 , 15 , 16 ]. Recent publications demonstrated that the EOS calculator, compared to conventional management strategies, shows lower relative risks for empirical antibiotic therapy without affecting safety [ 16 , 45 , 46 ].…”