Scripties UMCG - Rijksuniversiteit Groningen
English | Nederlands

The impact of the implementation of the new Dutch national guideline for the prevention and treatment of early-onset neonatal sepsis (EOS) on sepsis recognition and antibiotic reduction: A descriptive,retrospective study

(2019) Bantan, G. (Ghofran)

Objectives: A novel study to examine the effect of the most recent Dutch national guideline for the prevention and treatment of early-onset neonatal sepsis (EOS) on sepsis evaluation/recognition and antibiotic use in neonates in a non-academic hospital. Method: A descriptive, retrospective study that included 977 neonates born at the Martini Hospital from January 2010 through December 2018 who received antibiotic therapy within 72 hours postpartum for suspected EOS. Required data were collected from the available electronic patient records. Subsequently, the total population was divided into two subgroups based on their blood culture test results, namely a subgroup with positive blood cultures called ‘proven sepsis’ and a subgroup with negative blood cultures called ‘suspected sepsis’. In both subgroups the number of neonates who would be subjected to antibiotic therapy after applying the new national Dutch guideline for the prevention and treatment of EOS were studied. Descriptive statistical analyses were used to describe the study population and to calculate the prevalence of neonates with ‘proven sepsis’ and ‘suspected sepsis’. Main results: A total of 977 neonates were included in the study. The number of neonates with blood culture-confirmed EOS was 14 (1.4%) and 963 neonates (98.6%) had a negative blood culture. In the subgroup ‘proven sepsis’ 11 cultures contained Group B streptococcus (GBS), 2 contained Staphylococcus aureus (S. aureus) and one culture contained Escherichia coli (E. coli). By applying the recent EOS guidelines, empiric antibiotic treatment was recommended in all 14 neonates (100%) [95%CI, 0.768-1.000] within the group ‘proven sepsis’, and for 693 neonates (72%) out of 963 within the group ‘suspected sepsis’ [95%CI, 0.690-0.748]. 270 neonates (28%) out of 963 in the subgroup ‘suspected sepsis’ were found to have no recommendation of antibiotic treatment if the recent guidelines were applied [95% CI, 0.25-0.31]. Conclusion: The recently published risk-based guideline for EOS prevention and treatment could identify all neonates at risk of EOS and consequently reduce the proportion of neonates undergoing laboratory testing and receiving empirical antibiotic treatment by up to 28% compared to the previously used multivariable risk prediction models.

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