Huseynova Roya, Bin Mahmoud Latifa, Hamad Aljobair Fahad, Huseynov Ogtay, Career Halima, Jaganathan Parameaswari P, Abdelrahim Adli, Abduljabar Alaklobi Faisal A
Neonatal Intensive Care Unit, King Saud Medical City, Riyadh, Riyadh, SAU.
Infectious Diseases Department, King Saud Medical City, Riyadh, Riyadh, SAU.
Cureus. 2021 Apr 21;13(4):e14620. doi: 10.7759/cureus.14620.
Early-onset sepsis (EOS) refers to sepsis with onset before 72 hours of life. Kaiser Permanente Calculator (KPC) or EOS risk calculator is an advanced multivariate risk model for predicting EOS in infants. Objective To examine the EOS risk calculator effect for predicting neonatal EOS, the necessity for laboratory tests, antibiotic usage, and length of hospital stay among the term and late-preterm newborns. Method In this cross-sectional study, we evaluated 44 cases of neonates ≥34 weeks of gestation started on empiric antibiotics within 72 hours after birth due to suspected EOS at the neonatal intensive care unit (NICU). The study site is a 1,500-bed teaching hospital, with around 4,500 annual deliveries, 70 beds in the level II and level III tertiary care NICU. We calculated the risk of the incidence of EOS as one per 1000 live births. Then we retrospectively calculated the probability of neonatal early-onset infection at birth based on the EOS risk calculator and assigned each neonate to one of the recommended categories of the calculator. The primary outcome was to evaluate the infection risk calculator's effect for predicting neonatal EOS and antibiotic usage among the term and late-preterm newborns ≥34 weeks of gestation. Results In our data, EOS calculator showed unnecessary antibiotic usage for 12 (27.3%) neonates [relative risk reduction (RRR) 27.2%; 95% confidence interval (CI) 20.3% - 35.7%)]. EOS risk calculator implementation may decrease in the number of NICU admission (RRR 20.4%; 95% CI 14.3% - 28%), laboratory tests (RRR 20.4%; 95% CI 14.3% - 28%), and length of stay (RRR 25%; 95% CI 38% - 95%). Conclusion EOS calculator could be considered a strategic and objective implementation for managing EOS that can limit unnecessary laboratory tests, reduce antibiotic usage, and length of stay related to EOS. Our findings ensure a multicenter, randomized study evaluating the safety and general use of the calculator for EOS sepsis in Saudi Arabia's clinical practice.
早发型败血症（EOS）是指在出生72小时内发病的败血症。凯撒医疗集团计算器（KPC）或EOS风险计算器是一种用于预测婴儿EOS的先进多变量风险模型。目的 探讨EOS风险计算器在预测足月和晚期早产儿新生儿EOS、实验室检查必要性、抗生素使用及住院时间方面的效果。方法 在这项横断面研究中，我们评估了44例孕周≥34周的新生儿，这些新生儿因疑似EOS在出生后72小时内在新生儿重症监护病房（NICU）开始经验性使用抗生素。研究地点是一家拥有1500张床位的教学医院，每年约有4500例分娩，二级和三级重症监护NICU有70张床位。我们计算了EOS发病率的风险为每1000例活产中有1例。然后我们根据EOS风险计算器回顾性计算出生时新生儿早发型感染的概率，并将每个新生儿分配到计算器推荐的类别之一。主要结果是评估感染风险计算器在预测孕周≥34周的足月和晚期早产儿新生儿EOS及抗生素使用方面的效果。结果 在我们的数据中，EOS计算器显示12例（27.3%）新生儿使用抗生素不必要[相对风险降低（RRR）27.2%；95%置信区间（CI）20.3% - 35.7%]。实施EOS风险计算器可能会减少NICU入院人数（RRR 20.4%；95% CI 14.3% - 28%）、实验室检查（RRR 20.4%；95% CI 14.3% - 28%）和住院时间（RRR 25%；95% CI 38% - 95%）。结论 EOS计算器可被视为管理EOS的一种策略性和客观性的实施方法，它可以限制不必要的实验室检查，减少抗生素使用以及与EOS相关的住院时间。我们的研究结果确保了一项多中心、随机研究，以评估该计算器在沙特阿拉伯临床实践中用于EOS败血症的安全性和普遍适用性。
