Early-onset sepsis calculator helps reduce empirical antibiotics in newborns

  • Achten NB & al.
  • JAMA Pediatr
  • 5 Sep 2019

  • International Clinical Digest
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Takeaway

  • Compared with conventional management strategies, use of a neonatal early-onset sepsis (EOS) calculator appears to greatly reduce empirical antibiotics.
  • Safety data are limited but supportive.

Why this matters

  • Consistent use of any strategy (conventional, calculator, clinical surveillance) is essential for timely identification of infected newborns. See related editorial for more information.

Key results

  • 13 studies involving newborns before (n=66,949) and after (n=105,436) EOS calculator implementation; 3367 were included in the hypothetical database analysis.
  • Use of the EOS calculator to guide clinical decision-making yielded a 55% reduction in relative risk (RR) of antibiotic use (RR=0.45; 95% CI, 0.35-0.57).
  • Across all studies, there was no indication of increased EOS incidence, readmissions, antibiotic use 24-72 hours postbirth, proportion requiring ICU care, mortality with EOS calculator use.
  • Proportion of missed EOS cases was similar with the EOS calculator vs conventional management strategies (28% [5/18] vs 29% [8/28]; pooled OR=0.96, P=.95).

Study design

  • Systematic meta-review assessing neonatal EOS management by the EOS calculator vs conventional management strategies and reduction in empirical antibiotics.
  • Funding: Sophia, Coolsingel Foundations.

Limitations

  • Meta-review included some newborns.
  • Limited analysis.
  • Selection bias.
  • Limited generalisability.

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