240 - Reducing blood culture and antibiotic usage in neonates: Using quality improvement science to guide implementation of a neonatal early-onset sepsis calculator

Poster Board #: 240
Publication #: 2912-HP-QA.240

Background: Accurate identification and evaluation of well-appearing newborns at risk for early-onset sepsis (EOS) is critical to excellent newborn care. A maternal diagnosis of chorioamnionitis, often based on maternal peripartum fever of 100.4°F alone, has been commonly used nationwide as an indication for blood work evaluation and antibiotic administration in newborns. More recently, this practice has been questioned as new strategies such as the Kaiser Permanente EOS Risk Calculator have proven effective and safe at reducing unnecessary newborn antibiotic exposure.


Objective: Retrospective baseline data were collected between October 2017 and September 2018 at Massachusetts General Hospital. In a cohort of 288 well-appearing newborns ≥ 35 weeks gestation with maternal diagnosis of chorioamnionitis, 93.2% had blood work evaluation and 89.9% were treated with a 48-hour course of antibiotics. This was despite no culture-positive cases of sepsis. Our aim was to reduce by at least 50% within a six-month period the blood work evaluation and antibiotic treatment in well-appearing newborns ≥ 35 weeks gestation born to mothers with chorioamnionitis.


Design/Methods: Using a stepwise approach with plan-do-study-act (PDSA) cycles, we adopted the Kaiser Permanente EOS Risk Calculator to better identify high-risk neonates with maternal chorioamnionitis and to guide their management. We tracked the impact of the EOS Calculator by collecting longitudinal data after its implementation.


Results: From October 2018 to July 2020, 433 newborns with maternal chorioamnionitis were triaged using the EOS calculator. The rates of blood culture and antibiotic treatment decreased from 93.2 to 26.7% and 89.9 to 12.3%, respectively. We also observed a general decrease in blood culture and antibiotic utilization in all newborns ≥ 35 weeks gestation. In the larger population of 6,482 newborns ≥ 35 weeks gestation, the rate of blood culture and antibiotic treatment decreased from 12.8 to 5.8% and 9.9 to 2.5%, respectively.

Conclusion(s): The introduction of the EOS Calculator can substantially decrease the number of asymptomatic newborns requiring blood work evaluation and antibiotic treatment. Our results also indicate a favorable safety profile.


Antibiotic and culture rates for newborns ≥ 35 weeks gestation with maternal fever ≥ 100.4°F


Antibiotic and culture rates for all newborns ≥ 35 weeks gestation

---

Authors/Institutions: Giuseppina Romano-Clarke, Massachusetts General Hospital, Boston, Massachusetts, United States; Kamaris Merrit, Massachusetts General Hospital, Boston, Massachusetts, United States; Emily Ziady, Massachusetts General Hospital, Boston, Massachusetts, United States; Cathleen Durham, Massachusetts General Hospital, Boston, Massachusetts, United States; Jennifer Johnson, Massachusetts General Hospital, Boston, Massachusetts, United States; Sarah Morris, Massachusetts General Hospital, Boston, Massachusetts, United States; Brett D. Nelson, Massachusetts General Hospital, Boston, Massachusetts, United States