title: Reduction in the use of diagnostic tests in infants with risk factors for early-onset neonatal sepsis does not delay antibiotic treatment.
abstract: BACKGROUND
  Despite a low positive predictive value, diagnostic tests such as complete blood count (CBC) and C-reactive protein (CRP) are commonly used to evaluate whether infants with risk factors for early-onset neonatal sepsis (EOS) should be treated with antibiotics.
  
  
  METHODS
  We investigated the impact of implementing a protocol aiming at reducing the number of diagnostic tests in infants with risk factors for EOS in order to compare the diagnostic performance of repeated clinical examination with CBC and CRP measurement. The primary outcome was the time between birth and the first dose of antibiotics in infants treated for suspected EOS.
  
  
  RESULTS
  Among the 11,503 infants born at ≥35 weeks during the study period, 222 were treated with antibiotics for suspected EOS. The proportion of infants receiving antibiotics for suspected EOS was 2.1% and 1.7% before and after the change of protocol (p = 0.09). Reduction of diagnostic tests was associated with earlier antibiotic treatment in infants treated for suspected EOS (hazard ratio 1.58; 95% confidence interval [CI] 1.20-2.07; p <0.001), and in infants with neonatal infection (hazard ratio 2.20; 95% CI 1.19-4.06; p = 0.01). There was no difference in the duration of hospital stay nor in the proportion of infants requiring respiratory or cardiovascular support before and after the change of protocol.
  
  
  CONCLUSIONS
  Reduction of diagnostic tests such as CBC and CRP does not delay initiation of antibiotic treatment in infants with suspected EOS. The importance of clinical examination in infants with risk factors for EOS should be emphasised.
authors: Service of Neonatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Gilles.Duvoisin@chuv.ch.
authors: Gilles
authors: G
authors: Duvoisin
authors: Service of Neonatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Service of Neonatology, Hôpital Femme Mère Enfants, Hospices Civils de Lyon, Bron, France.
authors: Céline
authors: C
authors: Fischer
authors: Hospices Civils de Lyon, Service de Biostatistiques, Lyon, France; CNRS UMR 5558, Equipe Biostatistique Santé, Pierre-Bénite, France; Université Lyon I, Villeurbanne, France.
authors: Delphine
authors: D
authors: Maucort-Boulch
authors: Service of Neonatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors: Eric
authors: E
authors: Giannoni
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D001772:Blood Cell Count / Q000706:statistics & numerical data; D002097:C-Reactive Protein / Q000378:metabolism; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012307:Risk Factors; D018805:Sepsis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D061665:Time-to-Treatment
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein