This study evaluated the implementation effectiveness of the adapted AAP 2019 guidelines for early onset sepsis management in Thailand. By integrating the EOS calculator with an enhanced observation strategy, it effectively reduced unnecessary antibiotic use and tests, while ensuring timely treatment for genuine infection cases.
Literature Overview
The article, titled 'Clinical Outcomes of the Adapted AAP 2019 Guidelines on Early Onset Sepsis in Thailand,' published in the 'Antibiotics' journal, reviews and summarizes the application of early onset sepsis (EOS) management guidelines in Thailand. The study shows that hospitals can significantly reduce overtreatment of asymptomatic newborns while promptly identifying and managing infection cases by combining the EOS risk assessment calculator and enhanced observation strategy. This study provides important references for clinical practice and evidence-based optimization of antibiotic management.
Background Knowledge
Early onset sepsis (EOS) is a severe neonatal infectious disease primarily caused by Group B Streptococcus (GBS), typically occurring within 72 hours after birth. Although the global incidence of EOS has significantly declined due to prenatal screening and intrapartum antibiotic prophylaxis, clinical challenges of antibiotic overuse persist. This not only increases healthcare costs but may also lead to long-term health problems such as gut microbiota dysbiosis and spread of drug-resistant bacteria. Traditional management strategies, such as the CDC 2010 and AAP 2012 guidelines, recommend extensive evaluation and empirical antibiotic treatment for all high-risk newborns, but this approach may lead to antibiotic use up to 200 times higher than the actual infection rate. Therefore, in 2019, the AAP introduced three risk assessment strategies: risk stratification, the EOS calculator (EOSC), and enhanced observation. However, using EOSC or enhanced observation alone may miss some infection cases. Panyananthaphikkhu Chonprathan Medical Center combined these two approaches to develop AAP 2019 guidelines tailored to local epidemiology. This study aimed to evaluate the implementation outcomes in Thailand, focusing on balancing antibiotic use and EOS detection.
Research Methods and Experiments
The study employed a retrospective cohort observational design, including newborns born at ≥35 weeks gestation, divided into pre-guideline implementation (2017–2018) and post-implementation (2023–2024) groups. The primary evaluation metrics included laboratory testing rates, empirical antibiotic use rates, and clinical symptom changes. Data analysis was conducted using Pearson's chi-square test, Mann-Whitney U test, and binary logistic regression analysis, with statistical significance defined as p < 0.05.
Key Conclusions and Perspectives
Research Significance and Prospects
This study validates the feasibility of implementing the AAP 2019 guidelines within Thailand's healthcare system, offering evidence-based support for optimizing neonatal sepsis management. Future multicenter prospective studies could facilitate the adoption of this strategy across different healthcare systems, especially in low- and middle-income countries, to reduce antibiotic misuse and improve neonatal care quality.
Conclusion
This study demonstrates that by implementing the adapted AAP 2019 clinical management strategy, Panyananthaphikkhu Chonprathan Medical Center in Thailand effectively reduced empirical antibiotic use and unnecessary laboratory testing, while ensuring timely identification and treatment of true infection cases. The combination of the EOS calculator and enhanced observation offers more precise risk assessment and individualized treatment plans in clinical practice, particularly for asymptomatic newborns at EOS risk. Although the study has limitations due to its retrospective and single-center design, the findings provide important references for optimizing antibiotic management and improving neonatal outcomes. Future research should expand to multicenter settings to evaluate the strategy's applicability and safety across different healthcare environments, particularly for promoting standardized EOS management in low- and middle-income countries.
