Abstract
The neonatal early onset sepsis (EOS) calculator is a novel tool for antibiotic stewardship in newborns, associated with a reduction of empiric antibiotic treatment for suspected EOS. We studied if implementation of the EOS calculator results in less healthcare utilization and lower financial costs of suspected EOS. For this, we compared two single-year cohorts of hospitalizations within 3 days after birth in a Dutch nonacademic teaching hospital, before and after implementation of the EOS calculator. All admitted newborns born at or after 35 weeks of gestation were eligible for inclusion. We analyzed data from 881 newborns pre-implementation and 827 newborns post-implementation. We found significant reductions in EOS-related laboratory tests performed and antibiotic days, associated with implementation of the EOS calculator. Mean length of hospital stay was shorter, and EOS-related financial costs were lower after implementation among term, but not among preterm newborns.Conclusion: In addition to the well-known positive impact on antibiotic stewardship, implementation of the EOS calculator is also clearly associated with reductions in healthcare utilization related to suspected EOS in late preterm and term newborns and with a reduction in associated financial costs among those born term.What is Known:• The early-onset sepsis (EOS) calculator is a novel tool for antibiotic stewardship in newborns, associated with a reduction in empiric antibiotic treatment for suspected EOS.What is New:• In newborns at risk for EOS, EOS calculator implementation is associated with a significant reduction in laboratory investigations related to suspected EOS and significantly shorter stay in those born term.• EOS calculator implementation in term newborns is associated with a mean reduction of €207 in costs for EOS-related care per admitted newborn.
Highlights
In addition to the well-known positive impact on antibiotic stewardship, implementation of the early-onset sepsis (EOS) calculator is clearly associated with reductions in healthcare utilization related to suspected EOS in late preterm and term newborns and with a reduction in associated financial costs among those born term
The early-onset sepsis (EOS) calculator is a novel tool for antibiotic stewardship in newborns, associated with a reduction in empiric antibiotic treatment for suspected EOS
EOS calculator implementation in term newborns is associated with a mean reduction of €207 in costs for EOS-related care per admitted newborn
Summary
The neonatal early-onset sepsis (EOS) calculator is a novel tool for antibiotic stewardship in newborns [1]. The EOS calculator estimates the EOS risk based on five maternal and four neonatal objective clinical risk factors It stratifies newborns into three levels of risk with corresponding recommendations for management: (1) no additional care, (2) obtaining a blood culture and monitor vital signs for at least 24 hours, or (3) start treatment with empiric antibiotic therapy after obtaining a blood culture [1, 2]. Studies evaluating the EOS calculator have provided evidence of secondary benefits associated with EOS calculator implementation, such as reductions in the number of laboratory tests and blood cultures taken [2] and the rate of admissions to neonatal intensive care [5, 6] These findings, together with the reduction in empiric antibiotic treatment, suggest that the use of the EOS calculator may lead to a reduction in overall healthcare utilization and associated healthcare costs. Despite signs of significant uptake [8] and multiple reports on adoption of the EOS calculator [3, 9, 10], no real-world evidence of the effect of EOS calculator use on financial costs associated with healthcare for suspected EOS has been published
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