Improving Antibiotic Stewardship: Modifying the AAP Sepsis Guidelines with the Addition of the Neonatal Early Onset Sepsis Risk Calculator

Ellington, Marty; Naves, Esperanza; Williams, Kim; Kasat, Kavita

doi:10.1542/peds.144.2ma7.649

Cited by 1 publication

(3 citation statements)

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“…In addition, informal discussion with medical providers revealed that some had incorporated the EOS calculator in the evaluation of newborns ≥35 weeks' GA whenever there were new clinical concerns for infection during the first 24 hours of life. Our findings are in agreement with those in the original EOS implementation study at Kaiser Permanente, those reported by tertiary care centers both in the United States and internationally, [11][12][13][14][15] and the results of a recent systematic review and metaanalysis. 17 Although data from the original study and the results of this meta-analysis are encouraging, conflicting data still exist.…”

Section: Discussionsupporting

confidence: 92%

“…Since its initial implementation, the EOS calculator has been adopted at national and international tertiary care facilities. In all follow-up studies, the implementation of the EOS calculator has shown consistent reduction in blood work evaluation and antibiotics utilization 11–15…”

mentioning

confidence: 94%

“…In all follow-up studies, the implementation of the EOS calculator has shown consistent reduction in blood work evaluation and antibiotics utilization. [11][12][13][14][15] A retrospective review of a cohort of 3634 newborns ≥35 0 / 7 weeks' GA born at Massachusetts General Hospital (MGH) between April 2016 and December 2017 revealed that 12.8% of newborns had blood work evaluation and 9.9% were treated with antibiotics. However, only 1 newborn had a verified positive blood culture, reflecting a local EOS rate of 0.16/1000 births.…”

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confidence: 99%

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Reducing Blood Culture and Antibiotic Usage in Neonates

Romano-Clarke

Merrit

Ziady

et al. 2021

Advances in Neonatal Care

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Background: A maternal diagnosis of chorioamnionitis, based on maternal peripartum fever of 100.4°F alone, is commonly used as an indication for blood work and antibiotic treatment in newborns. New strategies such as the Kaiser Permanente early-onset sepsis (EOS) calculator have proven effective in identifying high-risk newborns and reducing unnecessary antibiotic administration. Purpose: Retrospective data from October 2017 to September 2018 from 297 well-appearing newborns ≥35 weeks' gestational age (GA) with maternal chorioamnionitis showed that 93.6% had blood work and 90.2% were treated with antibiotics. This was despite no culture-positive cases of sepsis. Our aim was to reduce by 50% blood work evaluation and antibiotic treatment within a 6-month period. Methods: Using plan-do-study-act (PDSA) cycles, we adopted the Kaiser Permanente EOS calculator. We collected longitudinal data to track the outcomes after its implementation. Results: In 423 newborns with maternal chorioamnionitis triaged with the EOS calculator from October 2018 to July 2020, the rates of blood culture and antibiotic treatment decreased from 93.6% to 26.7% and 90.2% to 12.3% (P < .0001). In the larger population of 6426 newborns ≥35 weeks' GA, the rate of blood culture and antibiotic treatment decreased from 12.8% to 5.8% and 9.9% to 2.5% (P < .0001). Implications for Practice: The EOS calculator substantially and safely decreases blood work and antibiotic administration in asymptomatic newborns with maternal chorioamnionitis. Implications for Research: Our findings provide further evidence for the effectiveness and safety of the EOS calculator.

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