Implementation of the sepsis risk score for chorioamnionitis-exposed newborns

Gievers, Ladawna; Sedler, Jennifer; Phillipi, Carrie A.; Dukhovny, Dmitry; Geddes, Jonah; Graven, Peter; Chan, Benjamin; Khaki, Sheevaun

doi:10.1038/s41372-018-0207-7

Cited by 18 publications

(26 citation statements)

References 26 publications

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“…The presented study is the first report from the Kingdom of Saudi Arabia on implementing the EOS calculator among newborns. Our study's results were comparable with other studies evaluating the infection calculator's validity [ 16 , 17 ]. By applying the EOS calculator in well-appearing and equivocal groups, we found that antibiotic usage could significantly decrease from 100.0% to 0 (P=0.0009) and from 100.0% to 33.3% (P=0.0035), respectively.…”

Section: Discussionsupporting

confidence: 89%

Use of Early-Onset Sepsis Risk Calculator for Neonates ≥ 34 Weeks in a Large Tertiary Neonatal Centre, Saudi Arabia

Huseynova

Mahmoud

Aljobair

et al. 2021

Cureus

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Early-onset sepsis (EOS) refers to sepsis with onset before 72 hours of life. Kaiser Permanente Calculator (KPC) or EOS risk calculator is an advanced multivariate risk model for predicting EOS in infants. ObjectiveTo examine the EOS risk calculator effect for predicting neonatal EOS, the necessity for laboratory tests, antibiotic usage, and length of hospital stay among the term and late-preterm newborns. MethodIn this cross-sectional study, we evaluated 44 cases of neonates ≥34 weeks of gestation started on empiric antibiotics within 72 hours after birth due to suspected EOS at the neonatal intensive care unit (NICU). The study site is a 1,500-bed teaching hospital, with around 4,500 annual deliveries, 70 beds in the level II and level III tertiary care NICU. We calculated the risk of the incidence of EOS as one per 1000 live births. Then we retrospectively calculated the probability of neonatal early-onset infection at birth based on the EOS risk calculator and assigned each neonate to one of the recommended categories of the calculator. The primary outcome was to evaluate the infection risk calculator's effect for predicting neonatal EOS and antibiotic usage among the term and late-preterm newborns ≥34 weeks of gestation. ResultsIn our data, EOS calculator showed unnecessary antibiotic usage for 12 (27.3%) neonates [relative risk reduction (RRR) 27.2%; 95% confidence interval (CI) 20.3% -35.7%)]. EOS risk calculator implementation may decrease in the number of NICU admission (RRR 20.4%; 95% CI 14.3% -28%), laboratory tests (RRR 20.4%; 95% CI 14.3% -28%), and length of stay (RRR 25%; 95% CI 38% -95%). ConclusionEOS calculator could be considered a strategic and objective implementation for managing EOS that can limit unnecessary laboratory tests, reduce antibiotic usage, and length of stay related to EOS. Our findings ensure a multicenter, randomized study evaluating the safety and general use of the calculator for EOS sepsis in Saudi Arabia's clinical practice.

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Section: Discussionsupporting

confidence: 89%

Use of Early-Onset Sepsis Risk Calculator for Neonates ≥ 34 Weeks in a Large Tertiary Neonatal Centre, Saudi Arabia

Huseynova

Mahmoud

Aljobair

et al. 2021

Cureus

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“…26,27,29 Ten of 13 studies were performed in the United States. 15,27,[29][30][31][33][34][35][36][37] The 13 included studies involved a total of 175 752 newborns. Of these, 172 385 were included in studies comparing cohorts before (66 949) and after (105 436) EOS calculator implementation, and 3367 were included in studies performing hypothetical database analysis.…”

Section: Characteristics and Participants Of Included Studiesmentioning

confidence: 99%

Association of Use of the Neonatal Early-Onset Sepsis Calculator With Reduction in Antibiotic Therapy and Safety

et al. 2019

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The neonatal early-onset sepsis (EOS) calculator is a clinical risk stratification tool increasingly used to guide the use of empirical antibiotics for newborns. Evidence on the effectiveness and safety of the EOS calculator is essential to inform clinicians considering implementation.OBJECTIVE To assess the association between management of neonatal EOS guided by the neonatal EOS calculator (compared with conventional management strategies) and reduction in antibiotic therapy for newborns.DATA SOURCES Electronic searches in MEDLINE, Embase, Web of Science, and Google Scholar were conducted from 2011 (introduction of the EOS calculator model) through January 31, 2019.STUDY SELECTION All studies with original data that compared management guided by the EOS calculator with conventional management strategies for allocating antibiotic therapy to newborns suspected to have EOS were included.DATA EXTRACTION AND SYNTHESIS Following PRISMA-P guidelines, relevant data were extracted from full-text articles and supplements. CHARMS (Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies) and GRADE (Grades of Recommendation, Assessment, Development and Evaluation) tools were used to assess the risk of bias and quality of evidence. Meta-analysis using a random-effects model was conducted for studies with separate cohorts for EOS calculator and conventional management strategies. MAIN OUTCOMES AND MEASURESThe difference in percentage of newborns treated with empirical antibiotics for suspected or proven EOS between management guided by the EOS calculator and conventional management strategies. Safety-related outcomes involved missed cases of EOS, readmissions, treatment delay, morbidity, and mortality. RESULTSThirteen relevant studies analyzing a total of 175 752 newborns were included. All studies found a substantially lower relative risk (range, 3%-60%) for empirical antibiotic therapy, favoring the EOS calculator. Meta-analysis revealed a relative risk of antibiotic use of 56% (95% CI, 53%-59%) in before-after studies including newborns regardless of exposure to chorioamnionitis. Evidence on safety was limited, but proportions of missed cases of EOS were comparable between management guided by the EOS calculator (5 of 18 [28%]) and conventional management strategies (8 of 28 [29%]) (pooled odds ratio, 0.96; 95% CI, 0.26-3.52; P = .95).CONCLUSIONS AND RELEVANCE Use of the neonatal EOS calculator is associated with a substantial reduction in the use of empirical antibiotics for suspected EOS. Available evidence regarding safety of the use of the EOS calculator is limited, but shows no indication of inferiority compared with conventional management strategies.

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“…Studies evaluating the EOS calculator have provided evidence of secondary benefits associated with EOS calculator implementation, such as reductions in the number of laboratory tests and blood cultures taken [2] and the rate of admissions to neonatal intensive care [5,6]. These findings, together with the reduction in empiric antibiotic treatment, suggest that the use of the EOS calculator may lead to a reduction in overall healthcare utilization and associated healthcare costs.…”

Section: Introductionmentioning

confidence: 99%

Early onset sepsis calculator implementation is associated with reduced healthcare utilization and financial costs in late preterm and term newborns

et al. 2020

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The neonatal early onset sepsis (EOS) calculator is a novel tool for antibiotic stewardship in newborns, associated with a reduction of empiric antibiotic treatment for suspected EOS. We studied if implementation of the EOS calculator results in less healthcare utilization and lower financial costs of suspected EOS. For this, we compared two single-year cohorts of hospitalizations within 3 days after birth in a Dutch nonacademic teaching hospital, before and after implementation of the EOS calculator. All admitted newborns born at or after 35 weeks of gestation were eligible for inclusion. We analyzed data from 881 newborns pre-implementation and 827 newborns post-implementation. We found significant reductions in EOS-related laboratory tests performed and antibiotic days, associated with implementation of the EOS calculator. Mean length of hospital stay was shorter, and EOS-related financial costs were lower after implementation among term, but not among preterm newborns.Conclusion: In addition to the well-known positive impact on antibiotic stewardship, implementation of the EOS calculator is also clearly associated with reductions in healthcare utilization related to suspected EOS in late preterm and term newborns and with a reduction in associated financial costs among those born term.What is Known: • The early-onset sepsis (EOS) calculator is a novel tool for antibiotic stewardship in newborns, associated with a reduction in empiric antibiotic treatment for suspected EOS. What is New:• In newborns at risk for EOS, EOS calculator implementation is associated with a significant reduction in laboratory investigations related to suspected EOS and significantly shorter stay in those born term. • EOS calculator implementation in term newborns is associated with a mean reduction of €207 in costs for EOS-related care per admitted newborn.

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Implementation of the sepsis risk score for chorioamnionitis-exposed newborns

Abstract: Algorithm implementation decreased antibiotic and resource utilization without missing cases of EOS.

Cited by 18 publications

References 26 publications

Use of Early-Onset Sepsis Risk Calculator for Neonates ≥ 34 Weeks in a Large Tertiary Neonatal Centre, Saudi Arabia

Use of Early-Onset Sepsis Risk Calculator for Neonates ≥ 34 Weeks in a Large Tertiary Neonatal Centre, Saudi Arabia

Association of Use of the Neonatal Early-Onset Sepsis Calculator With Reduction in Antibiotic Therapy and Safety

Early onset sepsis calculator implementation is associated with reduced healthcare utilization and financial costs in late preterm and term newborns

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