More than 80% of kids with low risk for sepsis received antibiotics, finds study

Multiple strategies are used to identify newborn infants at high risk of culture-confirmed early-onset sepsis (EOS). Delivery characteristics have been used to identify preterm infants at the lowest risk of infection to guide the initiation of empirical antibiotics. The researcher's objectives were to identify term and preterm infants at the lowest risk of EOS using delivery characteristics and to determine antibiotic use among them.

This was a retrospective cohort study of term and preterm infants born January 1, 2009, to December 31, 2014, with blood culture with or without cerebrospinal fluid culture obtained ≤72 hours after birth. Criteria for determining low EOS risk included: cesarean delivery, without labour or membrane rupture before delivery and no antepartum concern for intraamniotic infection or no reassuring foetal status. The researchers determined the association between these characteristics, the incidence of EOS, and antibiotic duration among infants without EOS.

The results of the study are:

Among 53 575 births, 7549 infants (14.1%) were evaluated and 41 (0.5%) of those evaluated had EOS. Low-risk delivery characteristics were present for 1121 (14.8%) evaluated infants, and none had EOS. Whereas antibiotics were initiated in a lower proportion of these infants (80.4% vs 91.0%, P < .001), the duration of antibiotics administered to infants born with and without low-risk characteristics was not different (adjusted difference 0.6 hours, 95% CI [−3.8, 5.1]).

Thus, the researchers concluded that the risk of EOS among infants with low-risk delivery characteristics is extremely low. Despite this, a substantial proportion of these infants are administered antibiotics. Delivery characteristics should inform empirical antibiotic management decisions among infants born at all gestational ages.

Reference:

Delivery Characteristics and the Risk of Early-Onset Neonatal Sepsis by Dustin D. Flannery, et al. published in the Pediatrics.

https://publications.aap.org/pediatrics/article-abstract/doi/10.1542/peds.2021-052900/184465/Delivery-Characteristics-and-the-Risk-of-Early?redirectedFrom=fulltext