학술논문
Comparison of diagnoses of early-onset sepsis associated with use of Sepsis Risk Calculator versus NICE CG149: a prospective, population-wide cohort study in London, UK, 2020-2021.
Document Type
Academic Journal
Author
Piyasena C; Evelina London Children's Hospital, London, UK.; Galu S; Homerton University Hospital NHS Foundation Trust, London, UK.; Yoshida R; Imperial College Healthcare NHS Trust, London, UK.; Thakkar D; The Hillingdon University Hospitals NHS Foundation Trust, Harrow, London, UK.; O'Sullivan J; Kingston Hospital NHS Foundation Trust, Kingston upon Thames, London, UK.; Longley C; Barts Health NHS Trust, London, UK.; Evans K; Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.; Sweeney S; London Neonatal Operational Delivery Network, London, UK.; Kendall G; University College London Hospitals NHS Foundation Trust, London, UK.; Ben-Sasi K; London North West University Healthcare NHS Trust, Harrow, UK.; Richards J; Neonatology, St George's Hospital, London, UK.; Harris C; King's College Hospital NHS Foundation Trust, London, UK.; Jagodzinski J; London Neonatal Operational Delivery Network, London, UK.; Demirjian A; Evelina London Children's Hospital, London, UK.; United Kingdom Health Security Agency, London, UK.; Lamagni T; United Kingdom Health Security Agency, London, UK.; Le Doare K; Centre for Neonatal and Paediatric Infection, St George's University of London, London, UK.; Heath PT; Centre for Neonatal and Paediatric Infection, St George's University of London, London, UK.; Battersby C; Neonatal Medicine, School of Public Health, Imperial College London Faculty of Medicine, London, UK c.battersby@imperial.ac.uk.
Source
Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE
Subject
Language
English
Abstract
Objective: We sought to compare the incidence of early-onset sepsis (EOS) in infants ≥34 weeks' gestation identified >24 hours after birth, in hospitals using the Kaiser Permanente Sepsis Risk Calculator (SRC) with hospitals using the National Institute for Health and Care Excellence (NICE) guidance.
Design and Setting: Prospective observational population-wide cohort study involving all 26 hospitals with neonatal units colocated with maternity services across London (10 using SRC, 16 using NICE).
Participants: All live births ≥34 weeks' gestation between September 2020 and August 2021.
Outcome Measures: EOS was defined as isolation of a bacterial pathogen in the blood or cerebrospinal fluid (CSF) culture from birth to 7 days of age . We evaluated the incidence of EOS identified by culture obtained >24 hours to 7 days after birth. We also evaluated the rate empiric antibiotics were commenced >24 hours to 7 days after birth, for a duration of ≥5 days, with negative blood or CSF cultures.
Results: Of 99 683 live births, 42 952 (43%) were born in SRC hospitals and 56 731 (57%) in NICE hospitals. The overall incidence of EOS (<72 hours) was 0.64/1000 live births. The incidence of EOS identified >24 hours was 2.3/100 000 (n=1) for SRC vs 7.1/100 000 (n=4) for NICE (OR 0.5, 95% CI (0.1 to 2.7)). This corresponded to (1/20) 5% (SRC) vs (4/45) 8.9% (NICE) of EOS cases (χ=0.3, p=0.59). Empiric antibiotics were commenced >24 hours to 7 days after birth in 4.4/1000 (n=187) for SRC vs 2.9/1000 (n=158) for NICE (OR 1.5, 95% CI (1.2 to 1.9)). 3111 (7%) infants received antibiotics in the first 24 hours in SRC hospitals vs 8428 (15%) in NICE hospitals.
Conclusion: There was no significant difference in the incidence of EOS identified >24 hours after birth between SRC and NICE hospitals. SRC use was associated with 50% fewer infants receiving antibiotics in the first 24 hours of life.
Competing Interests: Competing interests: CB reports grants and personal awards funded by the National Institute for Health Research, personal fees from Chiesi Pharmaceuticals and AbbVie Pharmaceuticals and is deputy chair of the NIHR Health Technology Assessment Prioritisation Committee for hospital-based care. PTH was a member of NICE CG149 guideline committee and deputy chair of NICE CG195 guideline committee. The other authors do not have any conflicts of interests to declare.
(© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Design and Setting: Prospective observational population-wide cohort study involving all 26 hospitals with neonatal units colocated with maternity services across London (10 using SRC, 16 using NICE).
Participants: All live births ≥34 weeks' gestation between September 2020 and August 2021.
Outcome Measures: EOS was defined as isolation of a bacterial pathogen in the blood or cerebrospinal fluid (CSF) culture from birth to 7 days of age . We evaluated the incidence of EOS identified by culture obtained >24 hours to 7 days after birth. We also evaluated the rate empiric antibiotics were commenced >24 hours to 7 days after birth, for a duration of ≥5 days, with negative blood or CSF cultures.
Results: Of 99 683 live births, 42 952 (43%) were born in SRC hospitals and 56 731 (57%) in NICE hospitals. The overall incidence of EOS (<72 hours) was 0.64/1000 live births. The incidence of EOS identified >24 hours was 2.3/100 000 (n=1) for SRC vs 7.1/100 000 (n=4) for NICE (OR 0.5, 95% CI (0.1 to 2.7)). This corresponded to (1/20) 5% (SRC) vs (4/45) 8.9% (NICE) of EOS cases (χ=0.3, p=0.59). Empiric antibiotics were commenced >24 hours to 7 days after birth in 4.4/1000 (n=187) for SRC vs 2.9/1000 (n=158) for NICE (OR 1.5, 95% CI (1.2 to 1.9)). 3111 (7%) infants received antibiotics in the first 24 hours in SRC hospitals vs 8428 (15%) in NICE hospitals.
Conclusion: There was no significant difference in the incidence of EOS identified >24 hours after birth between SRC and NICE hospitals. SRC use was associated with 50% fewer infants receiving antibiotics in the first 24 hours of life.
Competing Interests: Competing interests: CB reports grants and personal awards funded by the National Institute for Health Research, personal fees from Chiesi Pharmaceuticals and AbbVie Pharmaceuticals and is deputy chair of the NIHR Health Technology Assessment Prioritisation Committee for hospital-based care. PTH was a member of NICE CG149 guideline committee and deputy chair of NICE CG195 guideline committee. The other authors do not have any conflicts of interests to declare.
(© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)