PC1128: Use of the Early Onset Sepsis Calculator and Antibiotic Utilization in a High Altitude Neonatal Intensive Care Unit

Purpose/Objectives: The burden of early-onset neonatal Group B Strep (GBS) sepsis has decreased due to antenatal risk-based prevention, but nearly 30% of United States mothers, 10% of newborns, and most preterm infants are antibiotic exposed until proven culture negative. Empiric antibiotics induce resistant microbes and has long-lasting negative effects on the microbiome. Utilization of the Early Onset Sepsis (EOS) Calculator has decreased the use of empiric antibiotics on admission in many Neonatal Intensive Care Units (NICU), but infants born at high altitude may be inappropriately categorized as clinically ill due to their need for supplemental oxygen. Our objectives were to:
1. Adapt the EOS Risk Calculator to consider the need for supplemental oxygen in well infants born at high altitude.
2. Maintain or improve our already low admission antibiotic rate, while not missing a case of early-onset sepsis.

Design/Methods: The EOS calculator is widely accepted to quantify risk of EOS in infants born at ≥ 34 weeks gestation to decrease empiric antibiotics in non-infected neonates. The tool uses population prevalence, maternal data, and neonatal clinical status to determine risk. In our NICU, at an altitude of almost 7,000 feet, many newborns require oxygen, which infers clinical illness per the EOS calculator. To comply with a company-wide Quality Improvement (QI) initiative, we adjusted clinical exam criteria to assess clinical stability more accurately in the newborn with a mild oxygen requirement. Providers and specially trained nurses entered the maternal and infant data into the Electronic Medical Record (EMR) and categorized the infants as clinically well, equivocal, or clinically ill based on a revised standard within 1 hour of birth. Lab evaluation and antibiotic use was then dictated by calculator results. Monitoring of antibiotic use is done quarterly, and evaluation of calculator compliance and ongoing education is key to program success.

Results: Prior to the use of the EOS calculator, our admission antibiotic rate was between 15-25%. This rate has risen with the use of the EOS calculator. With initial adjustment of illness definitions, which allowed modest supplemental oxygen in the otherwise well infant, the rate decreased, but not to our former low levels. Further adjustment of criteria to allow time for oxygen requirement to stabilize resulted in greater reduction of admission antibiotic use, but still not to former levels. Overall antibiotic utilization remains static.

Conclusion/Discussion: Our aim was to utilize the EOS calculator to reduce antibiotic exposure in our newborns. Though oxygen for > 2 hours after birth generally infers illness, infants born at altitude may need oxygen when well. Despite adjustment, the value of the EOS calculator is limited in a high-altitude setting.