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The Kaiser-Permanente early onset sepsis calculator – a tool to reduce antibiotic use in the UK?

Presented as a poster at the Neonatal Society 2016 Summer Meeting.

Davidson SL, King R, Greig R, Hall M

University Southampton Hospital NHS Foundation Trust, UK

Background: Antibiotics are widely used for early onset neonatal sepsis (EOS) but proven bacterial infection is infrequent. In both the UK, where the indications for treatment are based on the NICE clinical guideline CG149, and in the USA, where the AAP guideline is used, concerns have been expressed about the high proportion of babies receiving systemic antibiotics. The Kaiser- Permanente EOS calculator has been developed in the US to quantitate the sepsis risk at birth for babies ≥ 34 weeks gestation, with the aim of reducing the frequency and duration of antibiotic treatment for EOS. Our study was conducted to determine, first, the frequency of antibiotic prescribing following the adoption of CG149, and, second, whether the implementation of the EOS calculator would have been associated with a reduction in the frequency of antibiotic prescribing in the UK setting.

Methods: A prospective study of neonates inborn during a 3-month period was conducted to document the frequency of antibiotic prescribing for EOS. All babies who received systemic antibiotics, based on CG149, were identified from clinical and laboratory records. Maternal perinatal information was also collected. Antibiotic-treated babies of ≥ 34 weeks gestation were divided into two groups: 25 babies with the lowest CRP measurements (Group 1 -“Lower Risk”) and 25 babies with the highest CRP measurement (Group 2 – “Higher Risk”). The risk of sepsis, using the EOS calculator, was calculated retrospectively for these babies, the evaluator being blind to the CRP results. On the basis of the calculated risk babies were categorised as: 1) Requiring antibiotics, 2) Requiring observation but no antibiotic treatment, 3) Routine care.

Results: 188 babies received antibiotics – 13.5% of all live inborn babies, shown in table 1. KPEOS calculator assessments for group 1 and 2 babies are shown in table 2. Use of the EOS calculator would have reduced antibiotic prescribing in these 50 babies by 70% – 60 % in Group 1 and 80% in Group 2. Three babies grew pathogens on blood cultures during the first 72 hours; neither CG149 nor the KPEOS calculator would have identified two and both CG149 and KPEOS would have identified one.

The Kaiser-Permanente early onset sepsis calculator – a tool to reduce antibiotic use in the UK?

Conclusion: The results of our study are consistent with other published reports which suggest that use of the EOS calculator would reduce antibiotic use by at least 50%. Further prospective large scale studies are required to determine whether this is a safe approach.

Corresponding author: Mh10@doctors.org.uk

References
1. Kuzniewicz M.W. et al. The Joint Commission Journal on Quality and Patient Safety 2016;42(5):232-239.
2. Kerste M, et al. The Journal of Maternal-Fetal and Neonatal Medicine 2016;7:1-6 [Epub ahead of print]

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