TY - JOUR
T1 - Sepsis calculator implementation reduces empiric antibiotics for suspected early-onset sepsis
AU - Achten, Niek B.
AU - Dorigo-Zetsma, J. Wendelien
AU - van der Linden, Paul D.
AU - van Brakel, Monique
AU - Plötz, Frans B.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - 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.
AB - 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.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85042121750&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29455368
U2 - https://doi.org/10.1007/s00431-018-3113-2
DO - https://doi.org/10.1007/s00431-018-3113-2
M3 - Article
C2 - 29455368
SN - 0340-6199
VL - 177
SP - 741
EP - 746
JO - European journal of pediatrics
JF - European journal of pediatrics
IS - 5
ER -