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Published on: August 30, 2018
Prospective Evaluation of Adherence to French Guidelines on Early Onset Sepsis Management
Florine Affichard1, Stéphanie Brunet1,2, Christelle El Hage1
1From the Pediatric Intensive Care Transport Team, Hôpital Robert Debré.
Insights
French guidelines for early onset sepsis (EOS) showed high adherence in antibiotic management. While most neonates received appropriate antibiotic therapy, a significant number had inadequate biological testing, highlighting areas for improvement in pediatric care.
Area of Science:
- Neonatal Medicine
- Pediatric Infectious Diseases
- Clinical Practice Guidelines
Background:
- Early onset sepsis (EOS) is a rare but life-threatening condition in newborns.
- French national guidelines were established in 2017 to enhance the management of pediatric sepsis.
- This study evaluated adherence to these guidelines regarding antibiotic therapy.
Purpose of the Study:
- To assess and quantify the appropriateness of antibiotic therapy management in neonates based on new French guidelines.
- To identify deviations from recommended practices in antibiotic use and diagnostic testing for suspected EOS.
Main Methods:
- A prospective observational study was conducted at a tertiary pediatric teaching hospital.
- Data were collected from neonates born at ≥ 34 weeks gestational age requiring emergency transport within 72 hours of life.
- The primary outcome measured was the rate of antibiotic therapy initiation or abstention that complied with French guidelines.
Main Results:
- 107 neonates were included; 54% had risk factors for EOS and 91% presented with symptoms.
- Antibiotic therapy was initiated in 71% of infants; 91% of cases demonstrated adequate antibiotic management.
- Despite high adherence in antibiotic therapy, 63% of infants received inadequate biological tests.
Conclusions:
- There was high adherence to French guidelines for early onset sepsis antibiotic therapy initiation or abstention.
- No EOS-related deaths occurred in the study cohort, indicating effective management.
- A significant proportion of neonates underwent inappropriate biological testing, suggesting a need for improved diagnostic practices.
Background:
Early onset sepsis (EOS) is rare but potentially lethal. French guidelines were published in 2017 to improve the care of children. The aim of this study was to qualify and quantify inadequate antibiotic therapy management compared with the recommendations made by the new French guidelines.
Methods:
This prospective observational study was conducted at the Robert Debré Hospital (Paris, France), a tertiary pediatric teaching center. Data were prospectively collected between May and October 2019. We included all neonates born at a gestational age ≥ 34 weeks who needed emergency transportation by the pediatric intensive care unit transport team during the first 72 hours of life. The primary outcome was the rate of antibiotic therapy initiation (or abstention) that did not respect the new French guidelines.
Results:
One hundred and seven patients were included. The median gestational age was 39 weeks and 6 days. Median weight was 3355 g. Fifty-eight births (54%) had at least 1 risk factor for EOS. Ninety-seven (91%) infants had at least 1 symptom of EOS, and 76 (71%) were treated with antibiotics. Three newborns (3%) had a documented EOS, and all of them survived. Antibiotic therapy initiation or abstention was adequate for 91% of our cohort (n = 107). Physicians prescribed inadequate biologic tests for 67 (63%) infants.
Conclusions:
There was a high adherence to the French EOS guidelines for antibiotic therapy initiation or abstention. No death related to EOS occurred in our cohort. Nevertheless, a high proportion of children had undergone inadequate biological tests.
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