Antibiotic stewardship for early-onset sepsis

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Pharmacology

Background:

• Antibiotics are frequently given to newborns to prevent early-onset sepsis.
• Current practices for sepsis evaluation and antibiotic administration are key to neonatal antibiotic stewardship.
• Reducing unnecessary antibiotic exposure is crucial for infant health.

Purpose of the Study:

• To evaluate strategies for optimizing antibiotic use in newborns at risk for early-onset sepsis.
• To identify methods for safely reducing empiric antibiotic therapy in neonates.
• To improve antibiotic stewardship in the neonatal intensive care unit.

Main Methods:

• Utilizing multivariate prediction models for sepsis risk assessment in infants born at or after 35 weeks' gestation.
• Incorporating serial physical examinations to guide antibiotic decisions.
• Analyzing delivery characteristics to identify low-risk preterm infants (<35 weeks' gestation).
• Leveraging epidemiological and microbiological data for pathogen-specific antibiotic selection.
• Optimizing the use of blood cultures and time to positivity data.

Main Results:

• Multivariate models can safely decrease empiric antibiotic use in infants born ≥35 weeks' gestation.
• Serial physical exams may reduce empiric antibiotic exposure.
• Delivery characteristics can identify low-risk preterm infants not requiring empiric therapy.
• Epidemiological and susceptibility data inform optimal antibiotic choice.
• Judicious use of blood culture data can shorten antibiotic duration.

Conclusions:

• Risk assessment tools and clinical observation can significantly reduce unnecessary antibiotic administration in newborns.
• Tailoring antibiotic therapy based on risk, pathogen data, and culture results improves stewardship.
• These approaches ensure effective sepsis treatment while minimizing risks of broad-spectrum antibiotic exposure.