Sepsis Calculator Reduces Antibiotic Therapy for Suspected Early-Onset Sepsis

Implementation of the sepsis calculator in daily clinical decision-making may be feasible in conjunction with existing protocols, with high adherence.

The implementation of a sepsis calculator resulted in a reduction of empirical use of antibiotics for early-onset sepsis without signs of delay or prolongation of treatment, according to research published in the European Journal of Pediatrics.

Significant overtreatment with antibiotics for suspected early-onset sepsis cases is a persistent clinical issue, resulting in unnecessary cost and risks to newborns. A single-center, European study evaluated the effect of implementing the online sepsis calculator for newborns in accordance with existing protocols.

A total of 1877 newborns ≥35 months of gestational age were prospectively evaluated, and a retrospective cohort of 2076 newborns with similar infection rates in the same hospital were used as a control group to perform impact analysis. 

Empirical treatment with intravenous antibiotics for suspected early-onset sepsis was reduced from 4.8% to 2.7% after implementation of the calculator, for a relative risk reduction of 44% (95% CI, 21.4%-59.5%). There was no evidence suggesting changes in time to treatment start, duration of treatment, or proven sepsis rates found during the study.

The results here demonstrate “a major opportunity to improve antibiotic stewardship in high-income settings” said the investigators, even though the retrospective nature of the control cohort meant factors other than the calculator implementation may explain the results. However, this type of study is a recommended alternative to more expensive and time-consuming randomized impact trials. “These findings provide ratio and incentive for multicenter, nationwide, randomized validation and implementation studies of systematic use of the sepsis calculator prediction model to further evaluate its effect in clinical practice in places other than the [United States],” concluded the researchers.

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Achten NB, Dorigo-Zetsma JW, van der Linden PD, van Brakel M, Plötz FB. Sepsis calculator implementation reduces empiric antibiotics for suspected early-onset sepsis [published online February 18, 2018]. Eur J Pediatr. doi: 10.1007/s00431-018-3113-2