BACKGROUND: Uncertainty about the presence of infection results in unnecessary and prolonged empiric antibiotic treatment of newborns at risk for early-onset sepsis (EOS). This study evaluates the impact of this uncertainty on the diversity in management. METHODS: A web-based survey with questions addressing management of infection risk-adjusted scenarios was performed in Europe, North America, and Australia. Published national guidelines (n = 5) were reviewed and compared with the results of the survey. RESULTS: 439 Clinicians (68% were neonatologists) from 16 countries completed the survey. In the low-risk scenario, 29% would start antibiotic therapy and 26% would not, both groups without laboratory investigations; 45% would start if laboratory markers were abnormal. In the high-risk scenario, 99% would start antibiotic therapy. In the low-risk scenario, 89% would discontinue antibiotic therapy before 72 hours. In the high-risk scenario, 35% would discontinue therapy before 72 hours, 56% would continue therapy for 5-7 days, and 9% for more than 7 days. Laboratory investigations were used in 31% of scenarios for the decision to start, and in 72% for the decision to discontinue antibiotic treatment. National guidelines differ considerably regarding the decision to start in low-risk and regarding the decision to continue therapy in higher risk situations. CONCLUSIONS: There is a broad diversity of clinical practice in management of EOS and a lack of agreement between current guidelines. The results of the survey reflect the diversity of national guidelines. Prospective studies regarding management of neonates at risk of EOS with safety endpoints are needed.

From the *Division of Infectious Diseases and Immunology Department of Pediatrics Erasmus MC University Medical Center Sophia Children's Hospital Rotterdam The Netherlands; †Division of Neonatology McMaster University Children's Hospital Hamilton Health Sciences Hamilton ON Canada; ‡Department of Neonatology Thomayer Hospital Prague Czech Republic; §Institute of Pathological Physiology 1st Medical Faculty Charles University Prague Czech Republic; ¶University Hospital Zurich Zurich Switzerland; ‖Department of Paediatrics University Hospital of North Norway Tromsø Norway; **Paediatric Research Group Faculty of Health Sciences University of Tromsø Arctic University of Norway Tromsø Norway; ††Department of Neonatology The Children's Hospital at Westmead New South Wales Australia; ‡‡Service of Neonatology University Hospital of Lausanne Lausanne Switzerland; §§Department of Pediatrics Hôpitaux Universitaires Paris Sud AP HP Le Kremlin Bicêtre France; ¶¶Paediatric Critical Care Research Group Mater Research Institute University of Queensland Brisbane Australia; ‖‖Department of Pediatrics Paediatric Intensive Care Unit Lady Cilento Children's Hospital Brisbane Australia; ***Department of Pediatrics University Children's Hospital Berne Berne Switzerland; and †††Department of Pediatrics Children's Hospital Lucerne Lucerne Switzerland

References provided by Crossref.org

Less is more: Antibiotics at the beginning of life

Analysis of Antibiotic Exposure and Early-Onset Neonatal Sepsis in Europe, North America, and Australia

Cost impact of procalcitonin-guided decision making on duration of antibiotic therapy for suspected early-onset sepsis in neonates