scholarly journals 831 Use of a neonatal sepsis risk calculator reduces antibiotic use and hospital admission length: implementation of a DGH pilot programme during the COVID-19 era

2021 ◽  
Author(s):  
Joana Rita Ladislau De Freitas ◽  
Lucy Webster ◽  
Sabina Checkets ◽  
Rashmi D’Souza ◽  
Maria Mendoza ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Neonatal Sepsis ◽  
Antibiotic Use ◽  
Risk Calculator ◽  
Pilot Programme ◽  
Sepsis Risk

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

2021 ◽  
pp. fetalneonatal-2020-321489
Author(s):  
Nitin Goel ◽  
Stephanie Cannell ◽  
Gemma Davies ◽  
Murali Sridhar Natti ◽  
Vickness Kirupaalar ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
Consensus Guideline ◽  
Risk Calculator ◽  
Live Births ◽  
Sepsis Risk ◽  
The Impact

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.

Implementation and Evaluation of the Early-Onset Sepsis Risk Calculator in a High-Risk University Nursery

2017 ◽  
Vol 57 (9) ◽  
pp. 1080-1085 ◽  
Author(s):  
Jessica B. Beavers ◽  
Shasha Bai ◽  
Jennifer Perry ◽  
Jordan Simpson ◽  
Sara Peeples
Keyword(s):  
Early Onset ◽  
Neonatal Intensive Care ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Risk Calculator ◽  
Admission Rates ◽  
Early Onset Sepsis ◽  
Sepsis Risk ◽  
Control And Prevention ◽  
Nicu Admission

There is growing interest in the Kaiser early-onset sepsis (EOS) risk calculator though institutions are hesitant to deviate from the Centers for Disease Control and Prevention guidelines and implement this in their hospitals. We describe the process of implementing routine use of the risk calculator in term and late preterm newborns delivered to mothers with chorioamnionitis in a level III neonatal intensive care unit (NICU). A retrospective chart review of infants delivered to mothers with chorioamnionitis from 2011 to 2014 was performed. Implementation of routine use of the calculator began in January 2015; preintervention and postintervention data were analyzed after a 9-month period of routine use. Following implementation, NICU admission rates, number of blood cultures drawn, and rates of antibiotic use dropped by 54%, 42%, and 59%, respectively ( P < .001). No negative outcomes were reported. In this article, we describe how the calculator was safely implemented in our NICU while decreasing the number of interventions.

Implementation of the Early-Onset Sepsis Risk Calculator at a Community Level I Nursery

2021 ◽  
pp. 000992282110647
Author(s):  
Sharmila Oak ◽  
Melanie Stempowski ◽  
Erin Frank
Keyword(s):  
Early Onset ◽  
Antibiotic Use ◽  
Culture Collection ◽  
Risk Calculator ◽  
Community Based ◽  
Exact Test ◽  
Early Onset Sepsis ◽  
Sepsis Risk ◽  
Level 1 ◽  
Level I

The objective of this retrospective cohort study was to decrease the frequency of laboratory draws and the number of neonates receiving empiric antibiotics who are born to mothers with chorioamnionitis from 100% to 50% 6 months following implementation of the sepsis risk calculator (SRC) at a level 1 community nursery. Data were compared pre- and post-implementation of the SRC using the Fischer’s exact test. The rate of intravenous (IV) antibiotic use decreased from 93% to 7% ( P < .0001). The rate of blood culture collection decreased from 100% to 46% ( P < .0001). With implementation of the SRC, administration of IV antibiotics, laboratory draws, and IV placement significantly decreased without increasing rates of early-onset sepsis in our patient population. Our study demonstrated that the SRC can be effectively and safely implemented at a level 1 community–based newborn nursery, resulting in a decrease in unnecessary medical treatment without negative patient outcomes.

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

Neonatology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Jessica Alexandra Kimpton ◽  
Amit Verma ◽  
Devangi Thakkar ◽  
Sophia Teoh ◽  
Aarti Verma ◽  
...  
Keyword(s):  
Blood Culture ◽  
Early Onset ◽  
Transitional Care ◽  
Antibiotic Use ◽  
Risk Calculator ◽  
Clinical Indicators ◽  
Nice Guideline ◽  
Early Onset Sepsis ◽  
Sepsis Risk ◽  
The Usa

<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.

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