Theoretical impact of a bedside decision-making tool on antibiotic use for suspected neonatal healthcare-associated infection: an observational study
Abstract Background and objectives Healthcare-associated infections (HAI) are a leading contributor to morbidity and mortality in hospitalised neonates. Diagnosing neonatal HAI is challenging owing to non-specific symptoms and lack of definitive diagnostic markers, contributing to high rates of inap...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12887-024-05323-8 |
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| author | Lizel Georgi Lloyd Mirjam Maria van Weissenbruch Adrie Bekker Cecilia Ferreyra Birgitta Gleeson Angela Dramowski |
| author_facet | Lizel Georgi Lloyd Mirjam Maria van Weissenbruch Adrie Bekker Cecilia Ferreyra Birgitta Gleeson Angela Dramowski |
| author_sort | Lizel Georgi Lloyd |
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| description | Abstract Background and objectives Healthcare-associated infections (HAI) are a leading contributor to morbidity and mortality in hospitalised neonates. Diagnosing neonatal HAI is challenging owing to non-specific symptoms and lack of definitive diagnostic markers, contributing to high rates of inappropriate antibiotic use. This study evaluated the theoretical impact of implementing a bedside tool for decision-making on antibiotic length of therapy (LOT). Methods This prospective observational physician-blinded study consecutively enrolled patients with suspected HAI events at a large South African neonatal unit from September 2022 to September 2023. The antibiotic decision-making tool included an infection prediction score (NeoHoP), and a point-of-care C-reactive protein test (CRP) performed at HAI diagnosis and 24 h later. The theoretical impact of the tool on antibiotic LOT was calculated. Results We recruited 180 neonates with 214 episodes of suspected HAI, of which 22 (10.3%) were proven HAI, 56 (26.2%) were presumed HAI and 136 (63.6%) had HAI ruled out. The median observed antibiotic LOT was three days (9 days for proven HAI, 7 days for presumed HAI, and 3 days for no HAI). The antibiotic decision-making tool would theoretically reduce overall antibiotic LOT by 2 days (p < 0.001), particularly in neonates where HAI was subsequently excluded. Conclusion We developed an antibiotic decision-making tool to support the clinical evaluation of suspected neonatal HAI and demonstrated a significant potential impact on reducing antibiotic LOT. Given increasing antibiotic resistance rates globally, this tool should be further evaluated to minimise unnecessary antibiotic use in hospitalised neonates. |
| format | Article |
| id | doaj-art-efc38a63495f4b02a160ff89ece9bbf8 |
| institution | Kabale University |
| issn | 1471-2431 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj-art-efc38a63495f4b02a160ff89ece9bbf82025-01-26T12:52:49ZengBMCBMC Pediatrics1471-24312025-01-0125111010.1186/s12887-024-05323-8Theoretical impact of a bedside decision-making tool on antibiotic use for suspected neonatal healthcare-associated infection: an observational studyLizel Georgi Lloyd0Mirjam Maria van Weissenbruch1Adrie Bekker2Cecilia Ferreyra3Birgitta Gleeson4Angela Dramowski5Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDivision IC Neonatology (NICU), Department of Pediatrics, VU University Medical CenterDepartment of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityFoundation for Innovative New DiagnosticsFoundation for Innovative New DiagnosticsDepartment of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityAbstract Background and objectives Healthcare-associated infections (HAI) are a leading contributor to morbidity and mortality in hospitalised neonates. Diagnosing neonatal HAI is challenging owing to non-specific symptoms and lack of definitive diagnostic markers, contributing to high rates of inappropriate antibiotic use. This study evaluated the theoretical impact of implementing a bedside tool for decision-making on antibiotic length of therapy (LOT). Methods This prospective observational physician-blinded study consecutively enrolled patients with suspected HAI events at a large South African neonatal unit from September 2022 to September 2023. The antibiotic decision-making tool included an infection prediction score (NeoHoP), and a point-of-care C-reactive protein test (CRP) performed at HAI diagnosis and 24 h later. The theoretical impact of the tool on antibiotic LOT was calculated. Results We recruited 180 neonates with 214 episodes of suspected HAI, of which 22 (10.3%) were proven HAI, 56 (26.2%) were presumed HAI and 136 (63.6%) had HAI ruled out. The median observed antibiotic LOT was three days (9 days for proven HAI, 7 days for presumed HAI, and 3 days for no HAI). The antibiotic decision-making tool would theoretically reduce overall antibiotic LOT by 2 days (p < 0.001), particularly in neonates where HAI was subsequently excluded. Conclusion We developed an antibiotic decision-making tool to support the clinical evaluation of suspected neonatal HAI and demonstrated a significant potential impact on reducing antibiotic LOT. Given increasing antibiotic resistance rates globally, this tool should be further evaluated to minimise unnecessary antibiotic use in hospitalised neonates.https://doi.org/10.1186/s12887-024-05323-8Neonatal healthcare-associated infections (HAI)Neonatal sepsisLow-and-middle incoome countries (LMICs)Antibiotic resistanceDiagnostic markersAntibiotic stewardship |
| spellingShingle | Lizel Georgi Lloyd Mirjam Maria van Weissenbruch Adrie Bekker Cecilia Ferreyra Birgitta Gleeson Angela Dramowski Theoretical impact of a bedside decision-making tool on antibiotic use for suspected neonatal healthcare-associated infection: an observational study BMC Pediatrics Neonatal healthcare-associated infections (HAI) Neonatal sepsis Low-and-middle incoome countries (LMICs) Antibiotic resistance Diagnostic markers Antibiotic stewardship |
| title | Theoretical impact of a bedside decision-making tool on antibiotic use for suspected neonatal healthcare-associated infection: an observational study |
| title_full | Theoretical impact of a bedside decision-making tool on antibiotic use for suspected neonatal healthcare-associated infection: an observational study |
| title_fullStr | Theoretical impact of a bedside decision-making tool on antibiotic use for suspected neonatal healthcare-associated infection: an observational study |
| title_full_unstemmed | Theoretical impact of a bedside decision-making tool on antibiotic use for suspected neonatal healthcare-associated infection: an observational study |
| title_short | Theoretical impact of a bedside decision-making tool on antibiotic use for suspected neonatal healthcare-associated infection: an observational study |
| title_sort | theoretical impact of a bedside decision making tool on antibiotic use for suspected neonatal healthcare associated infection an observational study |
| topic | Neonatal healthcare-associated infections (HAI) Neonatal sepsis Low-and-middle incoome countries (LMICs) Antibiotic resistance Diagnostic markers Antibiotic stewardship |
| url | https://doi.org/10.1186/s12887-024-05323-8 |
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