C-reactive protein- and clinical symptoms-guided strategy in term neonates with early-onset sepsis reduced antibiotic use and hospital stay: a quality improvement initiative
Abstract Background Early-onset sepsis (EOS) is a potentially life-threatening complication of birth. Clinical symptoms are often unspecific and biomarkers have low predictive values for EOS. Therefore, clinical suspicion often leads to antibiotic therapy in neonates with a negative blood culture. I...
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| Format: | Article |
| Language: | English |
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BMC
2020-11-01
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| Series: | BMC Pediatrics |
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| Online Access: | http://link.springer.com/article/10.1186/s12887-020-02426-w |
| _version_ | 1828468328881979392 |
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| author | Johan Gyllensvärd Fredrik Ingemansson Elisabet Hentz Marie Studahl Anders Elfvin |
| author_facet | Johan Gyllensvärd Fredrik Ingemansson Elisabet Hentz Marie Studahl Anders Elfvin |
| author_sort | Johan Gyllensvärd |
| collection | DOAJ |
| description | Abstract Background Early-onset sepsis (EOS) is a potentially life-threatening complication of birth. Clinical symptoms are often unspecific and biomarkers have low predictive values for EOS. Therefore, clinical suspicion often leads to antibiotic therapy in neonates with a negative blood culture. In the study we evaluated if a quality improvement initiative could reduce unwarranted antibiotic use in a safe way in term neonates with culture-negative sepsis. Methods The quality improvement initiative included new treatment guidelines and were introduced on 11 June 2018. The guidelines included C-reactive protein- and clinical symptoms-guided decision-making and shorter intravenous antibiotic therapy. All term neonates treated for EOS at Ryhov Hospital, Jönköping, Sweden were studied before (period 1: 2016–2017) and after the introduction of the new guidelines (period 2: 11 June 2018 to 30 Sept 2019). Laboratory and clinical data were analysed. Results There were 7618 term neonates in period 1 and 5005 term neonates in period 2. We identified 140 (1.8%) EOS in period 1 and 97 (1.9%) EOS in period 2. During period 1 and 2, there were 61 (61/140, 44%) and 59 (59/97, 61%) EOS neonates, respectively, who met the criteria for shorter antibiotic treatment. The number of positive blood cultures were seven (0.92/1000 live births) and five (1.0/1000 live births) in period 1 and 2. The median C-reactive protein were 52 mg/L (37–62) in period 1 and 42 mg/L (31–56) in period 2 in the group who met the criteria of the guidelines. The duration of antibiotic therapy (Median: seven vs. five days, p < 0.001) and hospital stay (Median: seven vs. five days, p < 0.001) as well as healthcare costs (decreased by €122,000/year) was reduced in the group who met the criteria after the introduction of the guidelines. Conclusion C-reactive protein- and clinical symptoms-guided decision-making for EOS significantly decreased the duration of antibiotic therapy and hospital stay, and hence reduced healthcare costs, with no reinfection in a cohort of term infants. Trial registration Trial registration number: ISRCTN29535824 . Date of registration: 28 May 2020. Retrospectively registered. |
| first_indexed | 2024-12-11T04:21:30Z |
| format | Article |
| id | doaj.art-9a9b04a6135f4a79a951bb25b80b2d90 |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-12-11T04:21:30Z |
| publishDate | 2020-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj.art-9a9b04a6135f4a79a951bb25b80b2d902022-12-22T01:21:06ZengBMCBMC Pediatrics1471-24312020-11-0120111010.1186/s12887-020-02426-wC-reactive protein- and clinical symptoms-guided strategy in term neonates with early-onset sepsis reduced antibiotic use and hospital stay: a quality improvement initiativeJohan Gyllensvärd0Fredrik Ingemansson1Elisabet Hentz2Marie Studahl3Anders Elfvin4Department of PediatricsDepartment of PediatricsDepartment of Pediatrics, Sahlgrenska University HospitalDepartment of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of GothenburgDepartment of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of GothenburgAbstract Background Early-onset sepsis (EOS) is a potentially life-threatening complication of birth. Clinical symptoms are often unspecific and biomarkers have low predictive values for EOS. Therefore, clinical suspicion often leads to antibiotic therapy in neonates with a negative blood culture. In the study we evaluated if a quality improvement initiative could reduce unwarranted antibiotic use in a safe way in term neonates with culture-negative sepsis. Methods The quality improvement initiative included new treatment guidelines and were introduced on 11 June 2018. The guidelines included C-reactive protein- and clinical symptoms-guided decision-making and shorter intravenous antibiotic therapy. All term neonates treated for EOS at Ryhov Hospital, Jönköping, Sweden were studied before (period 1: 2016–2017) and after the introduction of the new guidelines (period 2: 11 June 2018 to 30 Sept 2019). Laboratory and clinical data were analysed. Results There were 7618 term neonates in period 1 and 5005 term neonates in period 2. We identified 140 (1.8%) EOS in period 1 and 97 (1.9%) EOS in period 2. During period 1 and 2, there were 61 (61/140, 44%) and 59 (59/97, 61%) EOS neonates, respectively, who met the criteria for shorter antibiotic treatment. The number of positive blood cultures were seven (0.92/1000 live births) and five (1.0/1000 live births) in period 1 and 2. The median C-reactive protein were 52 mg/L (37–62) in period 1 and 42 mg/L (31–56) in period 2 in the group who met the criteria of the guidelines. The duration of antibiotic therapy (Median: seven vs. five days, p < 0.001) and hospital stay (Median: seven vs. five days, p < 0.001) as well as healthcare costs (decreased by €122,000/year) was reduced in the group who met the criteria after the introduction of the guidelines. Conclusion C-reactive protein- and clinical symptoms-guided decision-making for EOS significantly decreased the duration of antibiotic therapy and hospital stay, and hence reduced healthcare costs, with no reinfection in a cohort of term infants. Trial registration Trial registration number: ISRCTN29535824 . Date of registration: 28 May 2020. Retrospectively registered.http://link.springer.com/article/10.1186/s12887-020-02426-wBacterial infectionC-reactive proteinNeonatal sepsisAntibiotic therapyAntibiotic stewardshipQuality improvement |
| spellingShingle | Johan Gyllensvärd Fredrik Ingemansson Elisabet Hentz Marie Studahl Anders Elfvin C-reactive protein- and clinical symptoms-guided strategy in term neonates with early-onset sepsis reduced antibiotic use and hospital stay: a quality improvement initiative BMC Pediatrics Bacterial infection C-reactive protein Neonatal sepsis Antibiotic therapy Antibiotic stewardship Quality improvement |
| title | C-reactive protein- and clinical symptoms-guided strategy in term neonates with early-onset sepsis reduced antibiotic use and hospital stay: a quality improvement initiative |
| title_full | C-reactive protein- and clinical symptoms-guided strategy in term neonates with early-onset sepsis reduced antibiotic use and hospital stay: a quality improvement initiative |
| title_fullStr | C-reactive protein- and clinical symptoms-guided strategy in term neonates with early-onset sepsis reduced antibiotic use and hospital stay: a quality improvement initiative |
| title_full_unstemmed | C-reactive protein- and clinical symptoms-guided strategy in term neonates with early-onset sepsis reduced antibiotic use and hospital stay: a quality improvement initiative |
| title_short | C-reactive protein- and clinical symptoms-guided strategy in term neonates with early-onset sepsis reduced antibiotic use and hospital stay: a quality improvement initiative |
| title_sort | c reactive protein and clinical symptoms guided strategy in term neonates with early onset sepsis reduced antibiotic use and hospital stay a quality improvement initiative |
| topic | Bacterial infection C-reactive protein Neonatal sepsis Antibiotic therapy Antibiotic stewardship Quality improvement |
| url | http://link.springer.com/article/10.1186/s12887-020-02426-w |
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