Abstract Ref Number = APCP408
SEPSIS CALCULATOR TO SUPPORT ANTIBIOTIC STEWARDSHIP IN EARLY-ONSET NEONATAL SEPSIS A META ANALYSIS
Hardya Gustada Hikmahrachim,Dinarda Ulf Nadobudskaya,Sonia Miyajima Anjani,Albert You
Faculty of Medicine Universitas Indonesia Cipto Mangunkusumo General Hospital, Jakarta
Background : The difficulty of establishing diagnosis of neonatal sepsis makes the timing to start antibiotic remain as the biggest challenge. As a consequence, inappropriate antibiotic administration is common. Recently, risk estimation using sepsis calculator for EOS based on both maternal risk factors and infants’ clinical presentation was established. We then conducted a meta analysis to estimate sepsis calculator’s impact in daily clinical settings, especially antibiotic usage.
Material : A literature searching was done in Pubmed, EBSCO, Embase, and Scopus database from January 2011 (after sepsis calculator established) to June 2018. We include observational studies that compare sepsis calculator to recent neonatal sepsis guideline in terms of antibiotic administration, blood culture, and admission to neonatal intensive care unit (NICU). Literature searching, validation study, and assessment risk of bias were done independently by four author, while first author did the statistical analysis.
Results : Of the 35 studies, we found 5 cohort studies meeting criteria with total samples of 18.352 infants from various countries. Based on sample heterogeneity, we developed a random-effect meta analysis. The use of sepsis calculator reduces inappropriate use of antibiotics [RR 0.46 (95% CI: 0.41-0.51); p <0.001, z = 13.57], blood culture sampling [RR 0.46 (95% CI: 0.40-0.52); p <0.001, z = 12.11), and NICU admissions [RR 0.68 (95% CI: 0.59-0.78); p <0.001, z = 5.47). No safety issues were reported from all studies during the use of sepsis calculator.
Conclusions : The new EOS risk estimation using neonatal sepsis calculator is an easy, effective, and safe tool to improve antibiotic uses and outcomes. This calculator is ready to be implemented in all level of neonatal care unit.
Keywords: neonatal sepsis calculator risk estimation antibiotic use blood culture