Implementation of an adapted Sepsis Risk Calculator algorithm to reduce antibiotic usage in the management of early onset neonatal sepsis: a multicentre initiative in Wales, UK

Abstract

ObjectiveAssess the impact of introducing a consensus guideline incorporating an adapted Sepsis Risk Calculator (SRC) algorithm, in the management of early onset neonatal sepsis (EONS), on antibiotic usage and patient safety.DesignMulticentre prospective studySettingTen perinatal hospitals in Wales, UK.PatientsAll live births ≥34 weeks’ gestation over a 12-month period (April 2019–March 2020) compared with infants in the preceding 15-month period (January 2018–March 2019) as a baseline.MethodsThe consensus guideline was introduced in clinical practice on 1 April 2019. It incorporated a modified SRC algorithm, enhanced in-hospital surveillance, ongoing quality assurance, standardised staff training and parent education. The main outcome measure was antibiotic usage/1000 live births, balancing this with analysis of harm from delayed diagnosis and treatment, disease severity and readmissions from true sepsis. Outcome measures were analysed using statistical process control charts.Main outcome measuresProportion of antibiotic use in infants ≥34 weeks’ gestation.Results4304 (14.3%) of the 30 105 live-born infants received antibiotics in the baseline period compared with 1917 (7.7%) of 24 749 infants in the intervention period (45.5% mean reduction). All 19 infants with culture-positive sepsis in the postimplementation phase were identified and treated appropriately. There were no increases in sepsis-related neonatal unit admissions, disease morbidity and late readmissions.ConclusionsThis multicentre study provides evidence that a judicious adaptation of the SRC incorporating enhanced surveillance can be safely introduced in the National Health Service and is effective in reducing antibiotic use for EONS without increasing morbidity and mortality.

Analysis of Antibiotic Exposure and Early-Onset Neonatal Sepsis in Europe, North America, and Australia

“… 17 Although the proportion of neonates started on antibiotics was reduced by this tool, the lowest rate of antibiotic exposure reported after implementing the EOS calculator is 3.0%. 11 , 17 , 27 In our study, the only network using the EOS calculator decreased antibiotic treatment rates, but treatment rates after the intervention remained above all other networks. Seven networks used the serial physical examination approach, a strategy that has been associated with safe reduction of antibiotic use.…”

“…The proportion of neonates started on antibiotics in our study is at the low end of the up to 14% described in the literature. 11,17,24,27 Three of the 13 networks reported treatment rates below 2% with the lowest rate of 1.18% in Stockholm County. To our knowledge, this is the lowest rate reported in literature.…”

NICE guideline review: neonatal infection: antibiotics for prevention and treatment (NG195)

“…There are UK data indicating that judicious adaptation of the KPSRC, backed by a robust surveillance programme, enhanced in-hospital observation, and staff and parent education, will be safe in the National Health Service set-up 4. When considering introduction of the KPSRC in their clinical practice, it would be for individual trusts to determine whether the risks relating to diagnosis outweigh the benefits of earlier discharge and better patient flow-through.…”

“…The National Institute for Health and Care Excellence (NICE) published the first guideline (CG149) intended for management of early-onset sepsis in 2012; this has been updated (NG195) in 2021 3. The guideline refers to the use of Kaiser Permanente Sepsis Risk Calculator (KPSRC), which applies a multivariable modelling approach to predict individualised risk of EONS 4. The KPSRC has been used widely across the world; published reports indicate a significant reduction in antibiotic use without missing true cases of EONS 4–6…”

“…The guideline refers to the use of Kaiser Permanente Sepsis Risk Calculator (KPSRC), which applies a multivariable modelling approach to predict individualised risk of EONS 4. The KPSRC has been used widely across the world; published reports indicate a significant reduction in antibiotic use without missing true cases of EONS 4–6…”