Evaluating a Modified Use of the Kaiser Permanente Early-onset Sepsis Risk Calculator to Reduce Antibiotic Exposure: a Retrospective Study.

Autor:	Alhindi MY; Neonatology Division, Department of Pediatrics, King Abdulaziz Medical City (KAMC), Ministry of National Guard Health Affairs (MNGHA), Jeddah, Saudi Arabia.; Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia., Almalki FG; Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia faisal2018.6@gmail.com.; King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia., Al Saif S; Neonatal Intensive Care Department, Women's Health Specialized Hospital, Ministry of National Guard Health Affairs (MNGHA), Riyadh, Saudi Arabia.; Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia., Almalahi A; King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia.; Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia., Alsaegh MH; Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia.; King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia., Mustafa A; Neonatology Division, Department of Pediatrics, King Abdulaziz Medical City (KAMC), Ministry of National Guard Health Affairs (MNGHA), Jeddah, Saudi Arabia.; King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia., AlQurashi MA; Neonatology Division, Department of Pediatrics, King Abdulaziz Medical City (KAMC), Ministry of National Guard Health Affairs (MNGHA), Jeddah, Saudi Arabia.; Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia.
Jazyk:	angličtina
Zdroj:	BMJ paediatrics open [BMJ Paediatr Open] 2024 Jun 06; Vol. 8 (1). Date of Electronic Publication: 2024 Jun 06.
DOI:	10.1136/bmjpo-2024-002597
Abstrakt:	Background: Early-onset neonatal sepsis (EONS) remains an important disease entity due to very serious adverse outcomes if left untreated. Lack of diagnostic tools in identifying healthy from diseased neonates, and clinicians' fear of the missing positive-culture sepsis babies, or babies with clinical sepsis have led to overtreating and unnecessary antibiotic exposure. Kaiser Permanente EONS risk calculator is an internally validated tool that can predict EONS. This sepsis risk calculator (SRC) classifies neonates into three subgroups: (1) ill-appearing, (2) equivocal and (3) well-appearing. We propose a modification to this tool that aims to use it solely for well-appearing babies. This modification represents a more conservative approach to decrease antibiotic exposure and offers an alternative for those hesitant to fully implement this tool. Methods: This is a dual-centre retrospective study where data were extracted from the electronic medical records. Our primary outcome was to validate the modified use of the SRC with a two-by-two table. Specificity, negative predictive value and expected antibiotic reduction were used to evaluate the tool's feasibility. Result: Among 770 babies suspected of EONS, the feasibility of the modified use was tested. The expected antibiotic exposure reduction rate on the modification was 40.4% overall. The proposed modification resulted in a specificity and negative predictive value of 99.28% (95% CI: 97.92% to 99.85%) and 99.5% (95% CI: 99% to 99.8%), respectively. Conclusion: The modified use of the sepsis risk calculator has shown that it can safely reduce antibiotic exposure in well-appearing babies. The modified use is used as a 'rule out' test that can identify very low risk of EONS babies, and safely minimise antibiotic exposure. Further prospective studies are needed to examine the efficacy of this use, and quality improvement projects are required to evaluate its applicability in different clinical settings. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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