Implementation of the early-onset sepsis calculator in a tertiary care NICU

Early-onset sepsis (EOS) is a significant cause of neonatal morbidity and mortality. Due to fear of missing cases, many newborns are unnecessarily exposed to antibiotics. We implemented the neonatal EOS calculator to reduce over-utilization of antibiotics and decrease costs.

Quality improvement study.

Neonatal Intensive Care Unit (NICU).

Infants born at ≥34 weeks' gestation were divided between two periods: the pre-EOS calculator time frame and the post-EOS calculator time frame.

We changed our EOS evaluation for inborn infants by implementing the EOS-calculator and decreasing "rule-out sepsis" time frame from 48 to 36 hours for infants started on antibiotics.

1,306 infants, with similar demographics, were included: 814 in pre-EOS calculator time frame and 492 in post-EOS calculator time frame. Following our interventions, the percentage of NICU admissions ≥34 weeks' gestation started on antibiotics decreased from 62% to 51% (P < .01). In the chorioamnionitis subgroup, antibiotic starts decreased by 50% (P < .01). There was a reduction in days of therapy per 1,000 NICU (168 vs 110, P < .01) and total (93 vs 57, P < .01) patient days. Fewer patients had blood cultures drawn (84% vs 67%, P < .01) with a decrease in infants treated for culture-negative sepsis (7% vs 3%, P < .01). NICU and hospital length of stay reduced by 1 day (P < .01), equivalent to a savings of $916,000 to $1.84 million per 1,000 NICU patients in costs and savings of $5.82 million to $12.5 million per 1,000 NICU patients in charges.

Antibiotic usage significantly decreased, with substantial savings after implementation of the EOS calculator, without significant negative effects.