Prospective Evaluation of Adherence to French Guidelines on Early Onset Sepsis Management

BACKGROUND: Early onset sepsis (EOS) is rare but potentially lethal. French guidelines were published in 2017 to improve the care of children. The aim of this study was to qualify and quantify inadequate antibiotic therapy management compared with the recommendations made by the new French guidelines. METHODS: This prospective observational study was conducted at the Robert Debré Hospital (Paris, France), a tertiary pediatric teaching center. Data were prospectively collected between May and October 2019. We included all neonates born at a gestational age ≥ 34 weeks who needed emergency transportation by the pediatric intensive care unit transport team during the first 72 hours of life. The primary outcome was the rate of antibiotic therapy initiation (or abstention) that did not respect the new French guidelines. RESULTS: One hundred and seven patients were included. The median gestational age was 39 weeks and 6 days. Median weight was 3355 g. Fifty-eight births (54%) had at least 1 risk factor for EOS. Ninety-seven (91%) infants had at least 1 symptom of EOS, and 76 (71%) were treated with antibiotics. Three newborns (3%) had a documented EOS, and all of them survived. Antibiotic therapy initiation or abstention was adequate for 91% of our cohort (n = 107). Physicians prescribed inadequate biologic tests for 67 (63%) infants. CONCLUSIONS: There was a high adherence to the French EOS guidelines for antibiotic therapy initiation or abstention. No death related to EOS occurred in our cohort. Nevertheless, a high proportion of children had undergone inadequate biological tests.