Impact of a neonatal early-onset sepsis risk calculator on antibiotic use in a regional Australian hospital.

Abstract

Background

The neonatal Early Onset Sepsis (EOS) Calculator is an increasingly used risk stratification tool to guide clinical decision-making in investigation and management of neonates with presumed EOS. Although the evidence base supporting this tool is growing, there is little research regarding its application in regional, non-tertiary facilities.

Objectives/Aims

To evaluate the safety and efficacy of the online neonatal EOS Calculator in reducing investigation and empirical antibiotic use for presumed early onset sepsis in newborns at an Australian regional non-tertiary hospital. Method

Retrospective review of neonates born at ≥34+0 weeks gestation investigated and/or treated for presumed early onset sepsis across a two-year period within a 224-bed regional acute hospital in Victoria, Australia. Actual management of cases was compared to neonatal EOS Calculator recommendations to determine potential reductions in rates of investigations (blood cultures and/or other pathology testing) and empirical IV antibiotic use. Outcome data and blood culture results were used to assess safety.

Results

During the study period 296 neonates ≥34+0 weeks gestation were investigated for EOS; of these 292 received empirical IV antibiotics. Retrospective application of the Calculator using a conservative EOS incidence of 1/1000 live births reduced investigation by 44.3% and empirical antibiotic use by 48.9%. No true cases of culture-positive sepsis were identified.

Implications/Outcomes for Planned Research Project

Use of the neonatal EOS Calculator could substantially reduce rates of investigation and empirical antibiotic use at our facility. More data is needed to establish the safety of the Calculator.

Final Thoughts

This retrospective study has established the utility of the Calculator in the regional Australian setting, the first study of it’s kind to do so. Following this successful we are now liaising with Bendigo Base and Geelong University Hospital to commence a multi-site prospective study with roll out of Calculator across all three sites.