C-reactive protein- and clinical symptoms-guided strategy in term neonates with early-onset sepsis reduced antibiotic use and hospital stay: a quality improvement initiative [Elektronisk resurs]
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Gyllensvärd, Johan (författare)
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Ingemansson, Fredrik (författare)
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Hentz, Elisabet (författare)
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Studahl, Marie (författare)
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Elfvin, Anders (författare)
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H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus (utgivare)
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Linköpings universitet Institutionen för biomedicinska och kliniska vetenskaper (utgivare)
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Linköpings universitet Medicinska fakulteten (utgivare)
- Publicerad: BMC, 2020
- Engelska.
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Ingår i: BMC Pediatrics. - 1471-2431. ; 20:1
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- Relaterad länk:
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http://www.liu.se (Värdpublikation)
Sammanfattning
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- Background: Early-onset sepsis (EOS) is a potentially life-threatening complication of birth. Clinical symptoms are often unspecific and biomarkers have low predictive values for EOS. Therefore, clinical suspicion often leads to antibiotic therapy in neonates with a negative blood culture. In the study we evaluated if a quality improvement initiative could reduce unwarranted antibiotic use in a safe way in term neonates with culture-negative sepsis. Methods: The quality improvement initiative included new treatment guidelines and were introduced on 11 June 2018. The guidelines included C-reactive protein- and clinical symptoms-guided decision-making and shorter intravenous antibiotic therapy. All term neonates treated for EOS at Ryhov Hospital, Jonkoping, Sweden were studied before (period 1: 2016-2017) and after the introduction of the new guidelines (period 2: 11 June 2018 to 30 Sept 2019). Laboratory and clinical data were analysed. Results: There were 7618 term neonates in period 1 and 5005 term neonates in period 2. We identified 140 (1.8%) EOS in period 1 and 97 (1.9%) EOS in period 2. During period 1 and 2, there were 61 (61/140, 44%) and 59 (59/97, 61%) EOS neonates, respectively, who met the criteria for shorter antibiotic treatment. The number of positive blood cultures were seven (0.92/1000 live births) and five (1.0/1000 live births) in period 1 and 2. The median C-reactive protein were 52 mg/L (37-62) in period 1 and 42 mg/L (31-56) in period 2 in the group who met the criteria of the guidelines. The duration of antibiotic therapy (Median: seven vs. five days, p < 0.001) and hospital stay (Median: seven vs. five days, p < 0.001) as well as healthcare costs (decreased by euro122,000/year) was reduced in the group who met the criteria after the introduction of the guidelines. Conclusion: C-reactive protein- and clinical symptoms-guided decision-making for EOS significantly decreased the duration of antibiotic therapy and hospital stay, and hence reduced healthcare costs, with no reinfection in a cohort of term infants.
Ämnesord
- Medical and Health Sciences (hsv)
- Clinical Medicine (hsv)
- Pediatrics (hsv)
- Medicin och hälsovetenskap (hsv)
- Klinisk medicin (hsv)
- Pediatrik (hsv)
Genre
- government publication (marcgt)
Indexterm och SAB-rubrik
- Bacterial infection; C-reactive protein; Neonatal sepsis; Antibiotic therapy; Antibiotic stewardship; Quality improvement
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BMC Pediatrics