Neonatal Intensive Care Unit, University of Ioannina, School of Medicine, Ioannina, Greece.
Neonatal Intensive Care Unit, University of Ioannina, School of Medicine, Ioannina, Greece.
Early Hum Dev. 2021 Apr;155:105331. doi: 10.1016/j.earlhumdev.2021.105331. Epub 2021 Feb 12.
The management of neonates with early-onset sepsis (EOS) is based on maternal risk factors and infant clinical indications. An online sepsis risk calculator (SRC) has been established taking into consideration how clinical appearance modifies the initial risk for EOS.
To compare our clinical practice based on risk-factor guidance with that projected through the application of the SRC.
Retrospective cohort study.
All neonates ≥34 weeks' gestation, during 01/2019-8/2020. The SRC was applied retrospectively to determine the recommendation. EOS was defined based on a positive blood or cerebrospinal fluid culture-proven infection within 72 h of age. Clinical sepsis was defined according to the European Medicine Agency criteria.
Differences on antibiotic administration and management.
Overall, 2084 infants were identified, of whom 150 (7%) received antibiotics. Of them, 34 infants were diagnosed with clinical sepsis, while one was diagnosed with culture positive-proven EOS. Applying SRC, 87 (4%) infants would have received antibiotics. Clinical sepsis was diagnosed in 29 infants, while one infant had culture positive-proven EOS. Sixty-seven of 150 (45%) infants that received antibiotics would not have been treated based on SRC; five infants that developed clinical sepsis would have been missed with SRC. A 99.7% agreement between both guidance was found regarding infants not indicated for antibiotics. SRC application led to an absolute reduction of antibiotic administration by 2.93% (95% CI 2.19-3.75), p < 0.0001.
The adoption of SRC would have significantly reduced antibiotic usage; however, a significant portion of cases with clinical EOS would have been missed.
早发性败血症（EOS）新生儿的治疗管理基于产妇危险因素和婴儿临床指征。考虑到临床外观如何改变 EOS 的初始风险，建立了一种在线败血症风险计算器（SRC）。
比较我们基于危险因素指导的临床实践与通过应用 SRC 预测的结果。
回顾性队列研究。
纳入所有胎龄≥34 周的新生儿，时间为 2019 年 1 月至 2020 年 8 月。应用 SRC 回顾性确定建议。EOS 根据生后 72 小时内阳性血或脑脊液培养证实的感染定义。临床败血症根据欧洲药品管理局标准定义。
抗生素使用和管理的差异。
共有 2084 名婴儿被确定，其中 150 名（7%）接受了抗生素治疗。其中，34 名婴儿被诊断为临床败血症，1 名婴儿被诊断为培养阳性的 EOS。应用 SRC，87 名（4%）婴儿将接受抗生素治疗。29 名婴儿被诊断为临床败血症，1 名婴儿被诊断为培养阳性的 EOS。根据 SRC，150 名接受抗生素治疗的婴儿中有 67 名（45%）无需治疗；SRC 可能会错过 5 名患有临床败血症的婴儿。两种指南在不需要抗生素的婴儿方面有 99.7%的一致性。SRC 的应用使抗生素的使用绝对减少了 2.93%（95%CI 2.19-3.75），p<0.0001。
采用 SRC 将显著减少抗生素的使用；然而，将有相当一部分患有临床 EOS 的婴儿被漏诊。
