ABSTRACT
INTRODUCTION: Compared with multivariate risk assessment, traditional category-based risk assessment (CRA) approaches for neonatal early-onset sepsis (EOS) screening are usually straightforward to use, do not require electronic devices, but are associated with higher rates of antibiotic use. This study aims to evaluate the performance of a novel enhanced CRA (eCRA) framework on EOS admissions and antibiotic use and to investigate whether a modified version with adjustments in risk factor weighting can allow its performance to match the EOS calculator while remaining easy to implement. METHOD: This is a prospective, single-center, two-phase observational study. Infants of all gestations delivered in a tertiary hospital in Hong Kong with risk factors or clinical features of EOS were recruited. PHASE I: A novel eCRA framework (period 2) was compared with the CDC 2010-based protocol (period 1). PHASE II: A modified eCRA framework was compared theoretically with the EOS calculator. EOS-specific admissions and antibiotic use were measured. RESULTS: Phase I: 1,025 at-risk infants were recruited during period 2 and compared with 757 infants of period 1. Admissions and antibiotic use decreased from 45.8% to 29.4% and 41.1% to 28.2%, respectively. Antibiotics among those at-risk but well-appearing infants decreased from 25.3% to 16.3% (p < 0.001 for all). PHASE II: antibiotic use was similar (7.3 vs. 6.4%, p = 0.42) between the modified eCRA framework and the EOS calculator. CONCLUSIONS: An eCRA framework can effectively and safely provide individualized guidance for EOS screening without the need for tools such as the EOS calculator.
Subject(s)
Neonatal Sepsis , Sepsis , Humans , Infant , Infant, Newborn , Anti-Bacterial Agents/therapeutic use , Neonatal Sepsis/diagnosis , Neonatal Sepsis/drug therapy , Prospective Studies , Risk Assessment/methods , Risk Factors , Sepsis/diagnosisABSTRACT
BACKGROUND: The epidemiology of neonatal early-onset sepsis (EOS) has changed with time and with changes in prevention strategy. Population-representative contemporary data provide insights on how to further improve EOS prevention and triage strategies. METHODS: Neonates born in public hospitals in Hong Kong from January 1, 2006, to December 31, 2017 were included. The epidemiological characteristics of EOS and the use of intrapartum antibiotic prophylaxis (IAP) were compared between the 2 epochs before (January 1, 2006 to December 31, 2011) and after (January 1, 2012 to December 31, 2017) the territory-wide implementation of universal maternal group B Streptococcus (GBS) screening. RESULTS: EOS developed in 1.07 of live births (522/490,034). After the implementation of universal GBS screening, the EOS rate decreased in neonates born ≥34 weeks (1.17-0.56, P < 0.001) and remained similar in those born <34 weeks (7.8-10.9, P = 0.15), whereas the proportions of IAP coverage increased in both groups [7.6%-23.3% ( P < 0.001) and 28.5%-52.0% ( P < 0.001), respectively]. The major pathogen for EOS shifted from GBS to Escherichia coli , and for early-onset meningitis from GBS to Streptococcus bovis . IAP was associated with subsequent isolation of pathogens resistant to ampicillin [adjusted odds ratio (aOR) 2.3; 95% confidence interval (CI): 1.3-4.2], and second-generation [aOR 2.0; 95% CI: 1.02-4.3] and third-generation [aOR 2.2; 95% CI: 1.1-5.0] cephalosporins. CONCLUSIONS: Pathogen profile of EOS changed with the implementation of universal GBS screening. S. bovis has emerged as a more common pathogen associated with the risk of meningitis. IAP may not be as effective in reducing EOS rate among infants born <34 weeks as compared with those ≥34 weeks, and newer strategies may be needed.
