Antibiotic use rate in neonates: A comparison of categorical risk assessment and the sepsis calculator

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Abstract
Background: Early‐onset neonatal sepsis (EOS) is defined as an infection with a positive blood culture within the first 7 days of life. The categorical risk assessment guideline from the Centers for Disease Control and Prevention is used to manage high‐risk infants, but it often results in a high rate of antibiotic use. A neonatal early‐onset sepsis calculator (EOS calculator) was developed to reduce the overuse of antibiotics. Methods: A retrospective study was conducted among infants born ≥35 weeks' gestation admitted to Vajira Hospital between October 1, 2018, and September 30, 2019. Infants were included if they had at least one risk factor for EOS or symptoms suggesting EOS. Relevant data were collected to assess antibiotic use rates based on the categorical risk assessment and the EOS calculator. Antibiotic use rates between the two methods were compared using the chi‐square test. Results: A total of 177 infants were included in this study. The mean gestational age (±SD) was 38.5 ± 1.7 weeks, and the mean birth weight (±SD) was 2923.9 ± 516.3 g. According to local guidelines, antibiotics were administered to 73 infants (41.2%). One infant had culture‐proven EOS, yielding a prevalence among the total live births born at ≥35 weeks' gestation of 0.49 per 1000 live births (1/2031). No deaths were observed. Antibiotic use rates were 45.2% using the categorical risk assessment and 31.6% using the EOS calculator ( p < 0.001). Conclusion: The rate of antibiotic use was lower with the EOS calculator than with the categorical risk assessment.

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