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Quintero-Carreño LM, Quintero-Palacios MA, Palacios-Ariza MA, Morales-Vélez AM, Méndez-Vargas LM, Beltrán-Higuera S, Martínez LI, Prieto-Jure R. Agreement between an Early-Onset Neonatal Sepsis Risk Calculator and the Colombian Clinical Practice Guideline in Three Tertiary-Care Centers in Bogotá, Colombia. Am J Perinatol 2024; 41:e1197-e1204. [PMID: 36539208 PMCID: PMC11139499 DOI: 10.1055/a-2001-9012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Clinical practice guidelines (CPG) worldwide help steer the management of early-onset neonatal sepsis (EONS). These documents typically discourage the use of risk assessment tools. However, prior work has shown that the Kaiser Permanente calculator (Early-Onset Sepsis Calculator [EOScalc]) could be a useful tool in EONS risk assessment. This study aimed to determine the agreement between the recommendations of the Colombian EONS CPG and those of the EOSCalc tool in a cohort of newborns in Bogotá, Colombia. STUDY DESIGN Multicenter retrospective observational cohort study. We included newborns with a gestational age ≥ 34 weeks who were admitted to the neonatal care unit with a suspected diagnosis of EONS between 2017 and 2019. Agreement between the two tools was examined using Cohen's kappa under two scenarios (unequivocal and cautious). RESULTS Of the 23.490 live births, 470 (1.71%) were admitted to the neonatal care unit with a presumptive diagnosis of EONS. This diagnosis was confirmed in seven patients by means of blood cultures, with group B streptococcus the most common organism (57%; 95% confidence interval [CI]: 18.4-90.1). A single death occurred among the patients with confirmed EONS (lethality: 14.3%). The overall incidence of EONS was 0.298 per 1,000 live births. After splitting the recommendations into two scenarios regarding antibiotic use, unequivocal and cautious, the agreement between EOSCalc and the CPG was below 15% (6 and 14%, respectively). CONCLUSION Recommendations from the Colombian EONS CPG show poor agreement with the EOSCalc, with the latter detecting all newborns with EONS. Although the use of EOSCalc is clinically and administratively advantageous, further prospective studies are warranted to determine the safety of its implementation. KEY POINTS · Colombian EONS CPGs recommend that an outsized number of newborns be given antibiotics.. · The KP EOSCalc risk assessment calculator shows poor agreement with CPG recommendations.. · The Colombian CPGs should be updated to include the use of risk assessment calculators..
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Affiliation(s)
| | | | | | | | | | - Sandra Beltrán-Higuera
- Departamento de Infectología Pediátrica, Clínica pediátrica; Clínica Colsanitas, Grupo Keralty, Bogotá, Colombia
| | - Leslie Ivonne Martínez
- Unidad neonatal, Clínica Universitaria Colombia; Clínica Colsanitas, Grupo Keralty, Bogotá, Colombia
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van der Weijden BM, Plötz FB, Achten NB. A better sensitivity of centers for disease control guidelines for early-onset sepsis at four hours of age may not represent actual clinical superiority. Acta Paediatr 2022; 111:1460-1461. [PMID: 35318718 DOI: 10.1111/apa.16342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Bo M. van der Weijden
- Department of Paediatrics Tergooi Hospital Blaricum The Netherlands
- Department of Paediatrics Amsterdam University Medical Center Emma Children's Hospital Amsterdam The Netherlands
| | - Frans B. Plötz
- Department of Paediatrics Tergooi Hospital Blaricum The Netherlands
- Department of Paediatrics Amsterdam University Medical Center Emma Children's Hospital Amsterdam The Netherlands
| | - Niek B. Achten
- Department of Paediatrics Erasmus University Medical Centre Sophia Children’s Hospital Rotterdam The Netherlands
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Hershkovich–Shporen C, Guri A, Gluskina T, Flidel‐Rimon O. Centers for disease control and prevention guidelines identified more neonates at risk of early-onset sepsis than the Kaiser-Permanente calculator. Acta Paediatr 2022; 111:767-771. [PMID: 34932840 DOI: 10.1111/apa.16232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 01/25/2023]
Abstract
AIM Our aim was to retrospectively compare how many cases of early-onset sepsis (EOS) would have been predicted by the the Kaiser-Permanente (KP) calculator and the United States Centers for Disease Control and Prevention (CDC) guidelines. METHODS This observational retrospective cohort study comprised 50 newborn infants with documented EOS who were born at the Kaplan Medical Centre, Israel, between 2001 and 2018. We retrospectively evaluated whether the KP calculator and the CDC recommendations would have recommended antibiotic treatment if they had been implemented within four hours of birth. RESULTS EOS was diagnosed in 50 of the 109 877 infants born from 34 weeks of gestation. By four hours of birth, 18 were symptomatic, five had an equivocal clinical status, and 27 were asymptomatic. The KP calculator would have recommended antibiotic treatment for 19 (38%) neonates: 18 who were symptomatic and one who was initially asymptomatic. The CDC guidelines would have recommended antibiotic treatment for 27 (54%) nenonates: those 19 plus all 5 with equivocal status and other 3 who were asymptomatic. CONCLUSION Using the CDC guidelines would have identified more equivocal and asymptomatic EOS cases within four hours of birth than the KP calculator. Enhanced observation is recommended when using the KP calculator.
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Affiliation(s)
- Calanit Hershkovich–Shporen
- Department of Neonatology Kaplan Medical Centre Rehovot Israel
- The Hebrew University School of Medicine Hebrew University and Hadassah Medical Centre Jerusalem Israel
| | - Alex Guri
- The Hebrew University School of Medicine Hebrew University and Hadassah Medical Centre Jerusalem Israel
- Department of Paediatrics Kaplan Medical Centre Rehovot Israel
- Infectious Diseases Unit Kaplan Medical Centre Rehovot Israel
| | - Tatiana Gluskina
- The Hebrew University School of Medicine Hebrew University and Hadassah Medical Centre Jerusalem Israel
- Department of Paediatrics Kaplan Medical Centre Rehovot Israel
| | - Orna Flidel‐Rimon
- Department of Neonatology Kaplan Medical Centre Rehovot Israel
- The Hebrew University School of Medicine Hebrew University and Hadassah Medical Centre Jerusalem Israel
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Stratification of Culture-Proven Early-Onset Sepsis Cases by the Neonatal Early-Onset Sepsis Calculator: An Individual Patient Data Meta-Analysis. J Pediatr 2021; 234:77-84.e8. [PMID: 33545190 DOI: 10.1016/j.jpeds.2021.01.065] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/28/2020] [Accepted: 01/27/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To provide a comprehensive assessment of case stratification by the Neonatal Early-Onset Sepsis (EOS) Calculator, a novel tool for reducing unnecessary antibiotic treatment. STUDY DESIGN A systematic review with individual patient data meta-analysis was conducted, extending PROSPERO record CRD42018116188. Cochrane, PubMed/MEDLINE, EMBASE, Web of Science, Google Scholar, and major conference proceedings were searched from 2011 through May 1, 2020. Original data studies including culture-proven EOS case(s) with EOS Calculator application, independent from EOS Calculator development, and including representative birth cohorts were included. Relevant (individual patient) data were extracted from full-text and data queries. The main outcomes were the proportions of EOS cases assigned to risk categories by the EOS Calculator at initial assessment and within 12 hours. Evidence quality was assessed using Newcastle-Ottawa scale, Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies, and GRADE tools. RESULTS Among 543 unique search results, 18 were included, totaling more than 459 000 newborns. Among 234 EOS cases, EOS Calculator application resulted in initial assignments to (strong consideration of) empiric antibiotic administration for 95 (40.6%; 95% CI, 34.2%-47.2%), more frequent vital signs for 36 (15.4%; 95% CI, 11.0%-20.7%), and routine care for 103 (44.0%; 95% CI, 37.6%-50.6%). By 12 hours of age, these proportions changed to 143 (61.1%; 95% CI, 54.5%-67.4%), 26 (11.1%; 95% CI, 7.4%-15.9%), and 65 (27.8%; 95% CI, 22.1%-34.0%) of 234 EOS cases, respectively. CONCLUSIONS EOS Calculator application assigns frequent vital signs or routine care to a substantial proportion of EOS cases. Clinical vigilance remains essential for all newborns.
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Laccetta G, Ciantelli M, Tuoni C, Sigali E, Miccoli M, Cuttano A. Early-onset sepsis risk calculator: a review of its effectiveness and comparative study with our evidence-based local guidelines. Ital J Pediatr 2021; 47:73. [PMID: 33766096 PMCID: PMC7992929 DOI: 10.1186/s13052-021-01028-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/15/2021] [Indexed: 12/20/2022] Open
Abstract
Background According to most early-onset sepsis (EOS) management guidelines, approximately 10% of the total neonatal population are exposed to antibiotics in the first postnatal days with subsequent increase of neonatal and pediatric comorbidities. A review of literature demonstrates the effectiveness of EOS calculator in reducing antibiotic overtreatment and NICU admission among neonates ≥34 weeks’ gestational age (GA); however, some missed cases of culture-positive EOS have also been described. Methods Single-center retrospective study from 1st January 2018 to 31st December 2018 conducted in the Division of Neonatology at Santa Chiara Hospital (Pisa, Italy). Neonates ≥34 weeks’ GA with birth weight ≤ 1500 g, 34–36 weeks’ GA neonates with suspected intraamniotic infection and neonates ≥34 weeks’ GA with three clinical signs of EOS or two signs and one risk factor for EOS receive empirical antibiotics. Neonates ≥34 weeks’ GA with risk factors for EOS or with one clinical indicator of EOS undergo serial measurements of C-reactive protein and procalcitonin in the first 48–72 h of life; they receive empirical antibiotics in case of abnormalities at blood exams with one or more clinical signs of EOS. Two hundred sixty-five patients at risk for EOS met inclusion criteria; they were divided into 3 study groups: 34–36 weeks’ GA newborns (n = 95, group A), ≥ 37 weeks’ GA newborns (n = 170, group B), and ≥ 34 weeks’ GA newborns (n = 265, group A + B). For each group, we compared the number of patients for which antibiotics would have been needed, based on EOS calculator, and the number of the same patients we treated with antibiotics during the study period. Comparisons between the groups were performed using McNemar’s test and statistical significance was set at p < 0.05; post-hoc power analysis was carried out to evaluate the sample sizes. Results 32/265 (12.1%) neonates ≥34 weeks’ GA received antibiotics within the first 12 h of life. According to EOS calculator 55/265 (20.7%) patients would have received antibiotics with EOS incidence 2/1000 live births (p < 0.0001). Conclusion Our evidence-based protocol entails a further decrease of antibiotic overtreatment compared to EOS calculator. No negative consequences for patients were observed.
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Affiliation(s)
- Gianluigi Laccetta
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Maternal and Child Health, Santa Chiara Hospital, University of Pisa, Pisa, Italy.
| | - Massimiliano Ciantelli
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Maternal and Child Health, Santa Chiara Hospital, University of Pisa, Pisa, Italy.,Centro di Formazione e Simulazione Neonatale "NINA", Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Cristina Tuoni
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Maternal and Child Health, Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Emilio Sigali
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Maternal and Child Health, Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, Faculty of Medicine, University of Pisa, Pisa, Italy
| | - Armando Cuttano
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Maternal and Child Health, Santa Chiara Hospital, University of Pisa, Pisa, Italy.,Centro di Formazione e Simulazione Neonatale "NINA", Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Cardetti M, Rodríguez S, Sola A. Use (and abuse) of antibiotics in perinatal medicine. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.anpede.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Sola A, Mir R, Lemus L, Fariña D, Ortiz J, Golombek S. Suspected Neonatal Sepsis: Tenth Clinical Consensus of the Ibero-American Society of Neonatology (SIBEN). Neoreviews 2020; 21:e505-e534. [PMID: 32737171 DOI: 10.1542/neo.21-8-e505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Suspected neonatal sepsis is one of the most common diagnoses made in newborns (NBs), but very few NBs actually have sepsis. There is no international consensus to clearly define suspected neonatal sepsis, but each time that this suspected diagnosis is assumed, blood samples are taken, venous accesses are used to administer antibiotics, and the mother-child pair is separated, with prolonged hospital stays. X-rays, urine samples, and a lumbar puncture are sometimes taken. This is of concern, as generally <10% and no more than 25%-30% of the NBs in whom sepsis is suspected have proven neonatal sepsis. It seems easy to start antibiotics with suspicion of sepsis, but stopping them is difficult, although there is little or no support to maintain them. Unfortunately, the abuse of antibiotics in inpatient and outpatient NBs is foolish. Its negative impact on neonatal health and the economy is a public health problem of epidemiological and even epidemic proportions. This manuscript is a shortened version of the 10th Clinical Consensus of the Ibero-American Society of Neonatology (SIBEN) on suspected neonatal sepsis at the end of 2018, updated with publications from its completion to February 2020. This manuscript describes useful strategies for everyday neonatal practice when neonatal sepsis is suspected, along with important aspects about the indisputable value of clinical evaluation of the NB and about obtaining and interpreting blood cultures, urine cultures, and other cultures. Likewise, the low value of laboratory tests in suspected neonatal sepsis is demonstrated with evidence and clinical recommendations are made on the appropriate use of antibiotics.
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Affiliation(s)
- Augusto Sola
- Medical Director, Ibero-American Society of Neonatology, Wellington, FL
| | - Ramón Mir
- Neonatology Department Chief in Hospital de Clìnicas Universidad Nacional de Asunciòn, Paraguay
| | - Lourdes Lemus
- Departamento de Neonatología, Hospital de Pediatría UMAE, Instituto Mexicano del Seguro Social, Guadalajara Jalisco, México
| | - Diana Fariña
- Director of the Neonatal Intensive Care Unit, Hospital de Pediatría, Buenos Aires, Argentina
| | - Javier Ortiz
- Ángeles del Pedregal Hospital, Mexico City, Mexico
| | - Sergio Golombek
- Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, NJ
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Cardetti M, Rodríguez S, Sola A. [Use (and abuse) of antibiotics in perinatal medicine]. An Pediatr (Barc) 2020; 93:207.e1-207.e7. [PMID: 32680672 DOI: 10.1016/j.anpedi.2020.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The rational use of antibiotics (ATB) implies that patients receive those adequate for their clinical needs, in correct doses according to their individual conditions, during an adequate period of time, and at the lowest cost for them and their community. The highest rate of ATB abuse occurs during the perinatal period, despite the fact that there is evidence of multiple short- and long-term negative effects. Furthermore, this abuse is associated with increased costs of medical care. OBJECTIVE To update and report the evidence on the use, abuse, and adverse effects of ATB in perinatal medicine, and possible measures to prevent them, and thus improve health care outcomes and costs. METHODS A review and analysis was performed from the literature related to the use of ATB in perinatal medicine up to February 2020. RESULTS ATB abuse in perinatal medicine ranges from 50% to 70%, with even higher rates in some neonatal centres. Adverse effects include death, increased microbial resistance, along with microbiome abnormalities and dysbiosis that lead to serious life-long complications such as infections, allergies, autoimmune disorders, gastrointestinal disorders, arthritis, asthma, obesity, and perhaps cancer. Preventing and reducing the abuse of ATB would lead to better health and to significant savings in the health sector. In only 4neonatal intensive care units, with 1000 admissions per year, savings are estimated at US$230,000 per year. CONCLUSION The need to optimise the use of ATB in perinatal medicine has never been more urgent.
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Affiliation(s)
- Marcelo Cardetti
- Consejería RED SIBEN, Servicio de Neonatología Clínica y Maternidad, Centro de Endocrinología y Reproducción Humana (CERHU), San Luis, Argentina
| | - Susana Rodríguez
- Sociedad Iberoamericana de Neonatología (SIBEN). Docencia e Investigación, Hospital Juan P. Garrahan, Buenos Aires, Argentina.
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