Optimizing antibiotic use for early onset sepsis: A tertiary NICU experience

2019 ◽  
Vol 12 (3) ◽  
pp. 301-312 ◽  
Author(s):  
V. Arora ◽  
D. Strunk ◽  
S.H. Furqan ◽  
L. Schweig ◽  
C. Lefaiver ◽  
...  
Keyword(s):  
Early Onset ◽  
Antibiotic Use ◽  
Early Onset Sepsis

scholarly journals Evaluation of Early Onset Sepsis, Complete Blood Count, and Antibiotic Use in Gastroschisis

2017 ◽  
Vol 35 (04) ◽  
pp. 385-389
Author(s):  
Sadie Williams ◽  
Matthew Leonard ◽  
Eric Hall ◽  
Jose Perez ◽  
Jacqueline Wessel ◽  
...  
Keyword(s):  
Early Onset ◽  
Complete Blood Count ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Control Group ◽  
Typically Develop ◽  
Early Onset Sepsis ◽  
Mature Neutrophil ◽  
Reliable Marker ◽  
Culture Positive

Objective Gastroschisis is a congenital defect in which the abdominal viscera herniate through the abdominal wall. In this population, antibiotics are often initiated immediately following delivery; however, this may be unnecessary as infections typically develop as a consequence of chronic issues in gastroschisis. The objective of this study was to evaluate the incidence of culture positive early onset sepsis, the reliability of the immature to mature neutrophil count (I:T) ratio as an infectious biomarker, and antibiotic use in infants with gastroschisis. Study Design This retrospective chart review analyzed clinical data from 103 infants with gastroschisis and 103 weight-matched controls that were evaluated for early onset infection. Results Compared with the control group, there was a significantly increased percentage of infants with an I:T ratio > 0.2 in the gastroschisis group (43% vs. 12%, p < 0.001) and an increased percentage of infants exposed to greater than 5 days of antibiotics regardless of their I:T ratio (75% vs. 6%, p < 0.001). There were no episodes of culture positive early onset sepsis in either group. Conclusion Our results indicate that I:T ratio is not a reliable marker of infection in gastroschisis, and suggest that empiric septic evaluation and antibiotic use, immediately following delivery in gastroschisis infants, may be unnecessary.

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.

Vignettes Identify Variation in Antibiotic Use for Suspected Early Onset Sepsis

2021 ◽  
Vol 11 (7) ◽  
pp. 770-774
Author(s):  
Kurlen S. E. Payton ◽  
David Wirtschafter ◽  
Mihoko V. Bennett ◽  
William E. Benitz ◽  
Henry C. Lee ◽  
...  
Keyword(s):  
Early Onset ◽  
Antibiotic Use ◽  
Early Onset Sepsis

scholarly journals Managing Infants Exposed to Maternal Chorioamnionitis by the Use of Early-Onset Sepsis Calculator

2019 ◽  
Vol 6 ◽  
pp. 2333794X1983371 ◽  
Author(s):  
Vinay Sharma ◽  
Constance Adkisson ◽  
Kunal Gupta
Keyword(s):  
Gestational Age ◽  
Early Onset ◽  
Neonatal Intensive Care ◽  
Complete Blood Count ◽  
Admission Rate ◽  
Antibiotic Use ◽  
Laboratory Evaluation ◽  
Utilization Rate ◽  
Early Onset Sepsis ◽  
Sepsis Calculator

Objective. To reduce neonatal intensive care unit admission rate (NAR) and antibiotic utilization rate (AUR) in ≥36 weeks gestational age infants exposed to maternal chorioamnionitis (MC) through the application of early-onset sepsis calculator (EOSCAL). Study Design. This is a single-center cohort study. All infants born ≥36 weeks gestational age and exposed to MC were compared for NAR, AUR, and laboratory evaluation rate (LER) 2 years after and 1 year before the implementation of EOSCAL. Results. There is a significant decrease in NAR ( P < .001), AUR ( P < .04), and LER for blood culture, complete blood count, and C-reactive protein ( P < .001) after implementation of EOSCAL. If infants received antibiotics, it was for significantly less number of doses ( P < .01). There was no increase in the readmission rate. Conclusion. Use of EOSCAL significantly decreases the rate of NAR, AUR, and LER in infants exposed to MC, without affecting readmission rates and late antibiotic use.

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.

A Clinical Monitoring Approach for Early Onset Sepsis: A Community Hospital Experience

2021 ◽  
Author(s):  
Lisa Bain ◽  
Dharshi Sivakumar ◽  
Katherine McCallie ◽  
Malathi Balasundaram ◽  
Adam Frymoyer
Keyword(s):  
At Risk ◽  
Clinical Examination ◽  
Early Onset ◽  
Laboratory Testing ◽  
Community Hospital ◽  
Hospital Setting ◽  
Antibiotic Use ◽  
Adverse Outcomes ◽  
Laboratory Evaluation ◽  
Early Onset Sepsis

BACKGROUND: A serial clinical examination approach to screen late preterm and term neonates at risk for early onset sepsis has been shown to be effective in large academic centers, resulting in reductions in laboratory testing and antibiotic use. The implementation of this approach in a community hospital setting has not been reported. Our objective was to adapt a clinical examination approach to our community hospital, aiming to reduce antibiotic exposure and laboratory testing. METHODS: At a community hospital with a level III NICU and &gt;4500 deliveries annually, the pathway to evaluate neonates ≥35 weeks at risk for early onset sepsis was revised to focus on clinical examination. Well-appearing neonates regardless of perinatal risk factor were admitted to the mother baby unit with serial vital signs and clinical examinations performed by a nurse. Neonates symptomatic at birth or who became symptomatic received laboratory evaluation and/or antibiotic treatment. Antibiotic use, laboratory testing, and culture results were evaluated for the 14 months before and 19 months after implementation. RESULTS: After implementation of the revised pathway, antibiotic use decreased from 6.7% (n = 314/4694) to 2.6% (n = 153/5937; P &lt; .001). Measurement of C-reactive protein decreased from 13.3% (n = 626/4694) to 5.3% (n = 312/5937; P &lt; .001). No cases of culture-positive sepsis occurred, and no neonate was readmitted within 30 days from birth with a positive blood culture. CONCLUSIONS: A screening approach for early onset sepsis focused on clinical examination was successfully implemented at a community hospital setting resulting in reduction of antibiotic use and laboratory testing without adverse outcomes.

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