Snoek Linde, van Kassel Merel N, Krommenhoek Jurjen F, Achten Niek B, Plötz Frans B, van Sorge Nina M, Brouwer Matthijs C, van de Beek Diederik, Bijlsma Merijn W
Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands.
Department of Paediatrics, Tergooi Hospital, Rijksstraatweg 1, 1261 AN Blaricum, the Netherlands.
EClinicalMedicine. 2022 Jan 10;44:101270. doi: 10.1016/j.eclinm.2021.101270. eCollection 2022 Feb.
The early-onset sepsis calculator (EOSC) reduces unnecessary antibiotic treatment in newborns. However, its performance in identifying cases with early-onset disease (EOD) is unclear. We compared the sensitivity of the EOSC to the current Dutch and National Institute for Health and Care Excellence (NICE) guidelines when applied to a cohort of newborns with culture-positive early-onset sepsis and meningitis.
Culture-positive (GBS) and () sepsis and meningitis patients ≤3 days old with a gestational age ≥34 weeks, identified between 1/1/2018 and 31/1/2021 in a Dutch prospective nationwide cohort study were included. Cases were identified by treating physicians and microbiological surveillance. Primary outcome was the proportion of patients that would have been treated according to the EOSC, the Dutch, and the NICE EOD prevention guidelines. Differences between proportions were analysed using McNemar's test.
We included 81 GBS and 7 EOD cases. At 4 h after birth, the EOSC would have recommended antibiotic treatment in 32 (36%) patients, compared to 44 (50%) by the Dutch (<0·01) and 48 (55%) by the NICE guideline (<0·01). The EOSC would have initially recommended routine care for 52% of patients compared to 31% and 30% for the Dutch and NICE guidelines (<0·01). At 24 h after birth, the EOSC would have recommended antibiotic treatment in 54 (61%) infants compared to 64 (73%) by the Dutch ( = 0·02) and 63 (72%) by the NICE guidelines ( = 0·06).
The sensitivity of the EOSC in identifying cases of EOD is lower compared to both Dutch and NICE guidelines, especially directly after birth. The EOSC relies more on clinical symptoms and results in less overtreatment of healthy newborns at the cost of later antibiotic treatment in initially well-appearing EOD patients.
This work was supported by grants received from Netherlands Organization for Health Research and Development (ZonMw; NWO-Vidi-Grant (grant number 917·17·308); NWO-Vici-Grant (grant number 918·19·627)), the Academic Medical Centre (AMC Innovative Impulse Grant) and Steun Emma Foundation Grant.
早发型败血症计算器（EOSC）可减少新生儿不必要的抗生素治疗。然而，其在识别早发型疾病（EOD）病例方面的表现尚不清楚。我们将EOSC与当前荷兰和英国国家卫生与临床优化研究所（NICE）的指南应用于一组血培养阳性的早发型败血症和脑膜炎新生儿时的敏感性进行了比较。
纳入2018年1月1日至2021年1月31日在荷兰一项前瞻性全国队列研究中确定的胎龄≥34周、年龄≤3天的血培养阳性（B族链球菌[GBS]和[其他病原体]）败血症和脑膜炎患者。病例由治疗医生和微生物监测确定。主要结局是根据EOSC、荷兰和NICE的EOD预防指南接受治疗的患者比例。使用McNemar检验分析比例差异。
我们纳入了81例GBS和7例EOD病例。出生后4小时，EOSC会建议对32例（36%）患者进行抗生素治疗，而荷兰指南为44例（50%）（P<0.01），NICE指南为48例（55%）（P<0.01）。EOSC最初会建议对52%的患者进行常规护理，而荷兰和NICE指南分别为31%和30%（P<0.01）。出生后24小时，EOSC会建议对54例（61%）婴儿进行抗生素治疗，而荷兰指南为64例（73%）（P = 0.02），NICE指南为63例（72%）（P = 0.06）。
与荷兰和NICE指南相比，EOSC识别EOD病例的敏感性较低，尤其是在出生后不久。EOSC更多地依赖临床症状，导致对健康新生儿的过度治疗减少，但代价是最初表现良好的EOD患者后期接受抗生素治疗的机会减少。
这项工作得到了荷兰卫生研究与发展组织（ZonMw；荷兰科学研究组织[NWO]维迪资助[资助编号917·17·308]；NWO维西资助[资助编号918·19·627]）、学术医疗中心（AMC创新冲动资助）和斯滕·艾玛基金会资助的支持。
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