1026 Regional observational study of missed cases of neonatal early-onset sepsis associated with the use of the SRC compared to NICE CG149

Abstract

<h3>Aims</h3> The Kaiser Permanente Sepsis Risk Calculator (SRC) has been reported to reduce antibiotic usage in neonates, but concerns of an increased risk of missed cases of early onset sepsis (EOS), compared to the NICE CG149 has led to variation in practice. 10 out of 26 units in the region adopted the SRC during the Covid-19 pandemic to rationalise resources. We aimed to conduct a regional surveillance of ‘missed EOS’ cases in newborn infants. <h3>Methods</h3> As part a Neonatal Operational Delivery Network Task and Finish Group, a prospective observational study was conducted involving 26 NHS neonatal units over a 12 month period from September 2020 to August 2021. The eligible population were liveborn infants ≥34 weeks gestation who had a blood culture taken within 7 days. Missed cases were defined as: <i>infants who received antibiotics &gt;24 hours of age (but ≤7 days</i><i> of age) with EOS (defined a positive culture OR negative culture treated with 5 days of intravenous antibiotics)</i>. EOS with a positive culture was defined as bacterial pathogen in blood or CSF. A common dataset including maternal and infant characteristics and management were collected. To capture all screens for suspected EOS including readmissions post discharge, lists of microbiology samples from infants <i>≤</i>7 days old regardless of location of care were obtained. <h3>Results</h3> During the study period, there were 99683 livebirths ≥ 34 weeks; 56731 (57%) born in the 16 units following NICE and 42952 (43%) born in the 10 units using SRC. Overall, 12992/99683 (13%) received antibiotics for suspected EOS. The incidence of EOS with a positive culture was 0.65/1000 live births. In units using NICE, 16.3% of infants were treated with antibiotics compared with 8.8% of units using SRC. Of the 357 missed cases (167 NICE, 190 SRC), 6 babies had a positive culture*, of whom 2 died (table 1). The incidence of all missed cases in SRC units was 4.4/1000 versus 2.9/1000 in NICE units (odds ratio 1.5, 95%CI [1.2; 1.8]. The incidence of missed cases of EOS with positive culture was 2.3/100,000 for SRC versus 8.8/100,000 for NICE (odds ratio 0.3, 95%CI [0.03; 2.3] (table 2). <h3>Conclusion</h3> The use of the SRC was associated with around 50% reduction in the proportion of infants receiving empiric antibiotics compared to NICE CG149. Although the number of missed cases was higher in SRC units, this was not associated with increased severe adverse outcomes. These findings can help inform clinical guidelines as well as future randomised controlled trials. Further studies are required to determine the outcomes of the SRC compared to the NICE CG195 introduced in April 2021.