661 - Antibiotic Use in Infants born > 35 Weeks’ Gestation, Following Categorical Risk Assessment for Early Onset Sepsis versus Neonatal Early-Onset Sepsis Calculator

Early onset neonatal sepsis (EOS) is defined as infection with positive blood culture occurred within 7 days of life. The most important EOS-causing bacteria is group B Streptococcus (GBS) which can cause serious complications leading to disability and death. Recommendations using Categorical risk assessment from the Center for Disease Control and Prevention (CDC) and American Academy of Pediatrics (AAP) have been used to treat high risk infants, resulted in high rate of antibiotics use among non-infected infants especially in areas with low GBS incidence including Thailand. A risk assessment calculator by Puopolo et al (EOS calculator) has been developed to narrow the amounts of infants required antibiotics. However, rate of antibiotic used from this calculator in Thailand has not been studied.

Objective:

To study the rate of antibiotics used in infants > 35 weeks born at Vajira Hospital, who were assessed with Categorical risk assessment compared with EOS calculator.

Design/Methods: A retrospective study in infants born > 35 weeks gestation admitted at Vajira Hospital between 1 October 2018 and 30 September 2019 was conducted. Patients’ demographic data, and hospital course were recorded as well as rate of antibiotics used when assessed with Categorical risk assessment from CDC/AAP and EOS calculator.

Results:

The rate of antibiotics when evaluated by categorical risk assessment guideline is 83.6 % whereas the rate of antibiotics in accordance with the EOS calculator guidelines is 60.5 % (p-value < 0.001). Two infants were diagnosed with EOS based on blood cultures. The rate of infants undergoing laboratory testing was 94.9%. The median (interquartile range) of hospital stay was 5 (3-10) days. There were 7.9% of infants who were readmitted within 2 months, mostly from neonatal jaundice. No infants died.

Conclusion(s):

The use of EOS calculator can statistically significantly reduce the rate of antibiotics use in infants at risk for EOS compared with categorical assessment. Further study is warrant to evaluate outcome of infants truly managed by EOS calculator such as incidence of late onset sepsis or other infections beyond perinatal period.