Potential Impact of Umbilical-Cord-Blood Procalcitonin-Based Algorithm on Antibiotics Exposure in Neonates With Suspected Early-Onset Sepsis

Frontiers in Pediatrics

article

Noémie Huetz¹  Damien Masson²  Christèle Gras Le Guen³  Elise Launay³  Géraldine Gascoin¹  Bertrand Leboucher¹  Christophe Savagner¹  Jean B. Muller⁵  Sophie Denizot⁶  Cécile Boscher⁵  Jocelyne Caillon⁷ 

[1] Department of Neonatal Medicine, Angers University Hospital;Laboratory of Biochemistry, Nantes University Hospital;Clinical Investigation Center 004, Nantes University Hospital;Loire Infant Follow-Up Team (LIFT) Network;Department of Neonatal Medicine, Nantes University Hospital;Department of Neonatology, Polyclinique de l'Atlantique;Laboratory of Microbiology, Nantes University Hospital

关键词: early-onset neonatal infection;    risk stratification;    screening tool;    decrease antibiotics exposure;    biomarkers;    newborns;    antibiotic stewardship;   

DOI  :  10.3389/fped.2020.00127

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Context: The incidence of early-onset neonatal infection has greatly decreased, but a new diagnostic approach is needed to avoid overdiagnosis and overtreatment. The aim of this study was to assess the potential impact of an algorithm incorporating umbilical-cord-blood procalcitonin (PCT) level on neonatal antibiotics prescription rate as compared with current practice. Material and methods: We conducted a prospective study in three maternity wards in France. All term and preterm neonates with the usual risk factors for neonatal group B Streptococcus infection were eligible for umbilical-cord-blood PCT testing. We compared the proportion of neonates who were exposed early to antibiotics (before 6 days of life) to that of neonates for whom antibiotics prescription would be indicated according to the PCT-based algorithm. Results: Among the 3,080 neonates included, 1 neonate presented with certain infection and 38 neonates with probable infection. The global antibiotics prescription rate was 4.6% [95% confidence interval (CI), 4.1–5]. With the PCT-based algorithm, the potential decrease in prescription rate would be 1.8% (95% CI, 1.3–2.3), corresponding to a 39% (95% CI, 37.3–40.7) relative reduction in antibiotics exposure ( p < 0.05). Conclusion: These results suggest that the umbilical-cord-blood PCT-based algorithm could significantly help the clinicians in their antibiotic prescription decision to decrease neonatal antibiotics exposure as compared with current practice. If validated in a larger interventional randomized study, this approach could help clinicians stratify the risk of early-onset neonatal infection and initiate early antibiotics treatment in newborns at high risk of infection while limiting the deleterious effects of useless prescriptions in non-infected newborns.

【 授权许可】

CC BY