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Sepsis calculator implementation reduces empiric antibiotics for suspected early-onset sepsis

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Abstract

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%.

Conclusion: Pragmatic and feasible implementation of the sepsis calculator yields a 44% reduction of empirical use of antibiotics for EOS, without signs of delay or prolongation of treatment. These findings warrant a multicenter, nation-wide, randomized study evaluating systematic use of the sepsis calculator prediction model and its effects in clinical practice outside of the USA.

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.

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Abbreviations

EOS:

Early-onset sepsis

GBS:

Group B streptococcus

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Acknowledgements

We thank Sharon Tai for her help in data collection.

Author information

Authors and Affiliations

  1. Department of Paediatrics, Tergooi hospitals, Rijksstraatweg 1, 1261 AN, Blaricum, The Netherlands

    Niek B. Achten, Monique van Brakel & Frans B. Plötz

  2. Department of Microbiology, Tergooi hospitals, Blaricum, The Netherlands

    J. Wendelien Dorigo-Zetsma

  3. Department of Clinical Pharmacology, Tergooi hospitals, Blaricum, The Netherlands

    Paul D. van der Linden

Authors
  1. Niek B. Achten
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  2. J. Wendelien Dorigo-Zetsma
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  3. Paul D. van der Linden
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  4. Monique van Brakel
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  5. Frans B. Plötz
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Contributions

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.

Corresponding author

Correspondence to Niek B. Achten.

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Ethical approval

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.

Informed consent

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.

Additional information

Communicated by Patrick Van Reempts

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Achten, N.B., Dorigo-Zetsma, J., van der Linden, P.D. et al. Sepsis calculator implementation reduces empiric antibiotics for suspected early-onset sepsis. Eur J Pediatr 177, 741–746 (2018). https://doi.org/10.1007/s00431-018-3113-2

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  • DOI: https://doi.org/10.1007/s00431-018-3113-2

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