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Quality improvement
Early-onset sepsis: can we screen fewer babies safely?
  1. Julian Eason1,
  2. Hope Ward1,
  3. Olha Danko1,
  4. Kerrie Richardson1,
  5. Rima Vaitkute2,
  6. Roisin McKeon-Carter1
  1. 1 NICU, University Hospitals Plymouth NHS Trust, Plymouth, UK
  2. 2 Neonatal intensivårdavdelning, University of Göteborg, Göteborg, Sweden
  1. Correspondence to Dr Julian Eason, NICU, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK; j.eason{at}nhs.net

Abstract

Background Over the past 2–3 years at the Southwest Peninsula tertiary neonatal unit in Plymouth, the authors have observed an increase in the number of clinically well term infants being screened and treated with antibiotics for infection in accordance with NICE guidance. The aim of our study was to assess the safety of implementing the Kaiser Permanente Early Onset Sepsis (KPEOS) calculator to minimise antibiotic usage in term infants in line with antimicrobial stewardship, reducing separation from mother at birth and facilitating earlier discharge.

Methods A 2-year retrospective review of medical records from 2014 to 2015 inclusive revealed 9217 deliveries, with 1550 infants (16.8%) having risk factors, 945 (10.2%) being term infants. Of those, 507 (53.6%) had a clinical reason to screen and 438 (46.4%) had risk factors alone treated with antibiotics for variable periods of time. This enabled us to review our usual practice and compare it with our KPEOS implementation.

Intervention National Health Service England permission was obtained to implement the KPEOS for a 6-month period. We collected data on all 175 term infants with risk factors to compare with our previous practice when The National Institute for Health and Care Excellence and Royal College of Obstetrics and Gynaecology maternal guidance was being followed.

Results The percentage of infants screened with a suspected infection previously receiving 5 days of antibiotics reduced from 31% (136/438) to 5% (9/157, p<0.0001) using the KPEOS calculator. Clinically well infants with risk factors alone previously receiving 36 hours of antibiotics, reduced from 63% (275/438) to 3% (5/157, p<0.0001) of infants treated. There was no late-onset sepsis in this study cohort or any observed adverse outcomes.

Conclusion These results demonstrated a potentially safe and effective quality improvement (QI) in our hospital with fewer babies treated and a reduced length of stay for this cohort. Considering individual hospitals rates for term Group B Streptococcal sepsis, this QI may be a safe and economical alternative to current practices for screening well term infants.

  • early onset sepsis
  • sepsis calculator
  • nice
  • kaiser permanente
  • atain

https://doi.org/10.1136/archdischild-2019-317047

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    Footnotes

    • Twitter @Roisin@MckeonCarter

    • Correction notice This paper has been corrected since it was published Online First. Figure 3 was duplicated as figure 4. We have now inserted the correct image for figure 4.

    • Contributors All authors have contributed to the work. HW and JE have prepared the posters and manuscripts.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.