Screening for early-onset neonatal sepsis on the Kaiser Permanente sepsis risk calculator could reduce neonatal antibiotic usage by two-thirds.
Screening for early-onset neonatal sepsis on the Kaiser Permanente sepsis risk calculator could reduce neonatal antibiotic usage by two-thirds.
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DOI：
10.1002/ped4.12344
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发表时间：
2022-09
影响因子：
2.2
通讯作者：
中科院分区：
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早发性新生儿脓毒症（EONS）的有效筛查策略有可能减少新生儿大量肠外抗生素（PAb）的使用。比较CG149国家健康与护理卓越研究所（NICE）指南与Kaiser Permanente败血症风险计算器（SRC）在某地区综合医院（DGH）二级新生儿病房虚拟应用中预测的EONS管理决策。回顾了2019年2月至7月期间所有妊娠≥34周的新生儿EONS的孕产妇和新生儿危险因素、新生儿临床检查结果和微生物培养结果的医院记录，这些新生儿(1)根据CG149‐NICE指南进行管理，或(2)在英国温彻斯特的DGH出生后72小时内接受PAb治疗。使用其虚拟风险估计器获得SRC预测。在研究期间，60名婴儿在出生后72小时内接受了PAb治疗。其中，19例（31.7%）符合SRC的抗生素标准；20例（33.3%）符合加强观察的标准，没有一例培养证实的败血症。根据SRC预测，“≥1个NICE临床指标和≥1个危险因素”的新生儿最有可能出现脓毒症风险评分（SRS） bb0.3。妊娠37周以下出生（风险比[RR] = 2.31, 95%可信区间[CI]: 1.02-5.22）和胎膜破裂时间延长（RR = 3.14, 95% CI: 1.16-8.48）增加了SRS bb的风险[3]。在SRC上筛查EONS可能会使2级新生儿病房中足月和近期新生儿的PAb使用量减少68%。使用Kaiser Permanente脓毒症风险计算器筛查早发性新生儿脓毒症，而不是NICE的建议，可以减少足月和近足月新生儿在出生后72小时内的肠外抗生素使用68%。
Effective screening strategies for early‐onset neonatal sepsis (EONS) have the potential to reduce high volume parenteral antibiotics (PAb) usage in neonates. To compare management decisions for EONS, between CG149 National Institute for Health and Care Excellence (NICE) guidelines and those projected through the virtual application of the Kaiser Permanente sepsis risk calculator (SRC) in a level 2 neonatal unit at a district general hospital (DGH). Hospital records were reviewed for maternal and neonatal risk factors for EONS, neonatal clinical examination findings, and microbial culture results for all neonates born at ≥34 weeks’ gestation between February and July 2019, who were (1) managed according to CG149‐NICE guidelines or (2) received PAb within 72 h following birth at a DGH in Winchester, UK. SRC projections were obtained using its virtual risk estimator. Sixty infants received PAb within the first 72 h of birth during the study period. Of these, 19 (31.7%) met SRC criteria for antibiotics; 20 (33.3%) met the criteria for enhanced observations and none had culture‐proven sepsis. Based on SRC projections, neonates with ‘≥1 NICE clinical indicator and ≥1 risk factor' were most likely to have a sepsis risk score (SRS) >3. Birth below 37 weeks’ gestation (risk ratio [RR] = 2.31, 95% confidence interval [CI]: 1.02–5.22) and prolonged rupture of membranes (RR = 3.14, 95% CI: 1.16–8.48) increased the risk of an SRS >3. Screening for EONS on the SRC could potentially reduce PAb usage by 68% in term and near‐term neonates in level 2 neonatal units. Screening for early‐onset neonatal sepsis using the Kaiser Permanente Sepsis Risk Calculator, rather than NICE recommendations, could reduce parenteral antibiotic usage, within the first 72 h of birth, in term and near‐term neonates by 68%.
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