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Abstract：
BACKGROUND: The early-onset sepsis calculator (EOSC) reduces unnecessary antibiotic treatment in newborns. However, its performance in identifying cases with early-onset disease (EOD) is unclear. We compared the sensitivity of the EOSC to the current Dutch and National Institute for Health and Care Excellence (NICE) guidelines when applied to a cohort of newborns with culture-positive early-onset sepsis and meningitis.
METHODS: Culture-positive Streptococcus agalactiae (GBS) and Escherichia coli (E. coli) sepsis and meningitis patients ≤3 days old with a gestational age ≥34 weeks, identified between 1/1/2018 and 31/1/2021 in a Dutch prospective nationwide cohort study were included. Cases were identified by treating physicians and microbiological surveillance. Primary outcome was the proportion of patients that would have been treated according to the EOSC, the Dutch, and the NICE EOD prevention guidelines. Differences between proportions were analysed using McNemar\'s test.
RESULTS: We included 81 GBS and 7 E. coli EOD cases. At 4 h after birth, the EOSC would have recommended antibiotic treatment in 32 (36%) patients, compared to 44 (50%) by the Dutch (p<0·01) and 48 (55%) by the NICE guideline (p<0·01). The EOSC would have initially recommended routine care for 52% of patients compared to 31% and 30% for the Dutch and NICE guidelines (p<0·01). At 24 h after birth, the EOSC would have recommended antibiotic treatment in 54 (61%) infants compared to 64 (73%) by the Dutch (p = 0·02) and 63 (72%) by the NICE guidelines (p = 0·06).
CONCLUSIONS: The sensitivity of the EOSC in identifying cases of EOD is lower compared to both Dutch and NICE guidelines, especially directly after birth. The EOSC relies more on clinical symptoms and results in less overtreatment of healthy newborns at the cost of later antibiotic treatment in initially well-appearing EOD patients.
BACKGROUND: This work was supported by grants received from Netherlands Organization for Health Research and Development (ZonMw; NWO-Vidi-Grant (grant number 917·17·308); NWO-Vici-Grant (grant number 918·19·627)), the Academic Medical Centre (AMC Innovative Impulse Grant) and Steun Emma Foundation Grant.
METHODS: Culture-positive Streptococcus agalactiae (GBS) and Escherichia coli (E. coli) sepsis and meningitis patients ≤3 days old with a gestational age ≥34 weeks, identified between 1/1/2018 and 31/1/2021 in a Dutch prospective nationwide cohort study were included. Cases were identified by treating physicians and microbiological surveillance. Primary outcome was the proportion of patients that would have been treated according to the EOSC, the Dutch, and the NICE EOD prevention guidelines. Differences between proportions were analysed using McNemar\'s test.
RESULTS: We included 81 GBS and 7 E. coli EOD cases. At 4 h after birth, the EOSC would have recommended antibiotic treatment in 32 (36%) patients, compared to 44 (50%) by the Dutch (p<0·01) and 48 (55%) by the NICE guideline (p<0·01). The EOSC would have initially recommended routine care for 52% of patients compared to 31% and 30% for the Dutch and NICE guidelines (p<0·01). At 24 h after birth, the EOSC would have recommended antibiotic treatment in 54 (61%) infants compared to 64 (73%) by the Dutch (p = 0·02) and 63 (72%) by the NICE guidelines (p = 0·06).
CONCLUSIONS: The sensitivity of the EOSC in identifying cases of EOD is lower compared to both Dutch and NICE guidelines, especially directly after birth. The EOSC relies more on clinical symptoms and results in less overtreatment of healthy newborns at the cost of later antibiotic treatment in initially well-appearing EOD patients.
BACKGROUND: This work was supported by grants received from Netherlands Organization for Health Research and Development (ZonMw; NWO-Vidi-Grant (grant number 917·17·308); NWO-Vici-Grant (grant number 918·19·627)), the Academic Medical Centre (AMC Innovative Impulse Grant) and Steun Emma Foundation Grant.
摘要：
背景：早发性败血症计算器（EOSC）减少了新生儿不必要的抗生素治疗。然而,其在识别早发性疾病(EOD)病例方面的表现尚不清楚.当应用于培养阳性的早发性败血症和脑膜炎的新生儿队列时，我们将EOSC与当前的荷兰和国家健康与护理卓越研究所（NICE）指南的敏感性进行了比较。
方法：培养阳性无乳链球菌（GBS）和大肠杆菌（E.大肠杆菌）脓毒症和脑膜炎患者≤3天，胎龄≥34周，纳入了2018年1月1日至2021年31月1日在荷兰进行的一项前瞻性全国队列研究.通过治疗医生和微生物监测确定病例。主要结果是根据EOSC治疗的患者比例，荷兰人,和好的EOD预防指南。使用McNemar检验分析比例之间的差异。
结果：我们包括81例GBS和7例大肠杆菌EOD病例。出生后4小时，EOSC建议对32名（36％）患者进行抗生素治疗，相比44（50％）的荷兰（p<0·01）和48（55％）的NICE指南（p<0·01）。EOSC最初建议对52％的患者进行常规护理，而荷兰和NICE指南则为31％和30％（p<0·01）。出生后24小时，在54例(61%)婴儿中,EOSC会推荐抗生素治疗,相比之下,荷兰的64例(73%)(p=0·02)和NICE指南的63例(72%)(p=0·06).
结论：与荷兰和NICE指南相比，EOSC在识别EOD病例方面的敏感性较低，尤其是出生后。EOSC更多地依赖于临床症状，并以最初表现良好的EOD患者的后期抗生素治疗为代价，减少了对健康新生儿的过度治疗。
背景：这项工作得到了荷兰卫生研究与发展组织（ZonMw；NWO-Vidi-Grant（授权号917·17·308）；NWO-Vici-Grant（授权号918·19·627））的资助，学术医学中心（AMC创新冲动资助）和SteunEmma基金会资助。
方法：培养阳性无乳链球菌（GBS）和大肠杆菌（E.大肠杆菌）脓毒症和脑膜炎患者≤3天，胎龄≥34周，纳入了2018年1月1日至2021年31月1日在荷兰进行的一项前瞻性全国队列研究.通过治疗医生和微生物监测确定病例。主要结果是根据EOSC治疗的患者比例，荷兰人,和好的EOD预防指南。使用McNemar检验分析比例之间的差异。
结果：我们包括81例GBS和7例大肠杆菌EOD病例。出生后4小时，EOSC建议对32名（36％）患者进行抗生素治疗，相比44（50％）的荷兰（p<0·01）和48（55％）的NICE指南（p<0·01）。EOSC最初建议对52％的患者进行常规护理，而荷兰和NICE指南则为31％和30％（p<0·01）。出生后24小时，在54例(61%)婴儿中,EOSC会推荐抗生素治疗,相比之下,荷兰的64例(73%)(p=0·02)和NICE指南的63例(72%)(p=0·06).
结论：与荷兰和NICE指南相比，EOSC在识别EOD病例方面的敏感性较低，尤其是出生后。EOSC更多地依赖于临床症状，并以最初表现良好的EOD患者的后期抗生素治疗为代价，减少了对健康新生儿的过度治疗。
背景：这项工作得到了荷兰卫生研究与发展组织（ZonMw；NWO-Vidi-Grant（授权号917·17·308）；NWO-Vici-Grant（授权号918·19·627））的资助，学术医学中心（AMC创新冲动资助）和SteunEmma基金会资助。
