Impact of a Neonatal Early-onset Sepsis Risk Calculator on Antibiotic Use in a Regional Australian Hospital

Aims The aim of this study is to evaluate the safety and efficacy of the online neonatal EOS Calculator at an Australian regional hospital. In addition, the utility of commonly used biomarkers as screening tools for suspected Early Onset Sepsis (EOS) was also assessed. Background Early onset sepsis is a potentially fatal condition; however, it is also rare, and remains a diagnostic challenge. Despite evidence against the use of non-specific infection biomarkers in neonates, many neonatal facilities worldwide continue to use these to investigate and guide management of neonatal EOS. Nevertheless, there is little research regarding use of the neonatal EOS Calculator in Australian and non-tertiary facilities. Objective This study sought to evaluate the safety and efficacy of the online neonatal EOS Calculator at an Australian regional hospital. Methods Retrospective review of neonates born at ≥34+0 weeks gestation investigated and/or treated for presumed early onset sepsis across a two-year period within a 224-bed regional acute hospital in Victoria, Australia. Actual management was compared to neonatal EOS Calculator recommendations to determine the potential reduction in investigations and empiric intravenous antibiotic use. Outcome data and blood culture results were used to assess safety. Levels of commonly used biomarkers were compared to EOS calculation and clinical examination findings. Results Retrospective application of the EOS Calculator among 296 subjects with presumed EOS was shown to reduce investigation by 44.3% and empirical antibiotic use by 48.9%. No true cases of culture-positive sepsis were identified. Elevated initial C-reactive protein (CRP) correlated positively with high EOS Calculation results and clinical illness on examination; however, there was absent or negative correlation of EOS risk with other biomarkers. Conclusion Use of the neonatal EOS Calculator may substantially reduce rates of investigation and empirical antibiotic use at regional facilities. However, more data is needed to establish the safety of the calculator. Biomarkers are of low value in clinical decision making with well infants and may hinder decision making when compared to the EOS Calculator and clinical examination.