Objective: We sought to compare the incidence of early-onset sepsis (EOS) in infants ≥34 weeks’ gestation identified > 24 hours after birth, in hospitals using the Kaiser Permanente sepsis risk calculator (SRC) with hospitals using the NICE guidance.
Design and setting: Prospective observational population-wide cohort study involving all 26 hospitals with neonatal units co-located with maternity services across London (10 using SRC, 16 using NICE). Participants: All livebirths ≥34 weeks’ gestation between September 2020 and August 2021.
Outcome measures: EOS was defined as isolation of a bacterial pathogen in the blood or CSF culture from birth to 7 days of age. We evaluated the incidence of EOS identified by culture obtained >24 hours to 7 days after birth. We also evaluated the rate empiric antibiotics were commenced >24 hours to 7 days after birth, for a duration of ≥5 days, with negative blood or CSF cultures.
Results: Of 99,683 livebirths, 42,952 (43%) were born in SRC hospitals and 56,731 (57%) in NICE hospitals. The overall incidence of EOS (<72 hours) was 0·64/1000 livebirths. The incidence of EOS identified >24 hours was 2.3/100,000 (n=1) for SRC versus 7.1/100,000 (n=4) for NICE (odds ratio 0·5, 95%CI [0·1; 2·7]). This corresponded to (1/20) 5% (SRC) versus (4/45) 8.9% (NICE) of EOS cases (chi=0.3, p=0.59). Empiric antibiotics were commenced >24 hours to 7 days after birth in 4·4/1000 (n=187) for SRC versus 2·9/1000 (n=158) for NICE (odds ratio 1·5, 95%CI [1·2; 1·9]). 3111 (7%) infants received antibiotics in the first 24 hours in SRC hospitals versus 8428 (15%) in NICE hospitals.
Conclusion: There was no significant difference in the incidence of EOS identified >24 hours after birth between SRC and NICE hospitals. SRC use was associated with 50% fewer infants receiving antibiotics in the first 24 hours of life.