Anti-microbial stewardship: antibiotic use in well-appearing term neonates born to mothers with chorioamnionitis

OBJECTIVE: To determine if implementation of a protocol based on a neonatal early-onset sepsis ( EOS) calculator developed by Kaiser Permanente would safely reduce antibiotic use in well-appearing term infants born to mothers with chorioamnionitis in the unique setting of an Observation Nursery. STUDY DESIGN: Data obtained from a retrospective chart review of well-appearing term infants born between 2009 and 2016 were entered into the EOS calculator to obtain management recommendations. RESULTS: Three hundred and sixty- two infants met the study criteria. Management according to the EOS calculator would reduce antibiotic use from 99% to 2.5% (P < 0.0001) of patients. Average length of therapy would also decrease from 2.08 to 0.05 days (P < 0.0001). One infant, who remained asymptomatic, had Enterococcus bacteremia and received a 7-day course of broadspectrum antibiotics. CONCLUSIONS: Culture-positive sepsis in asymptomatic neonates born to mothers with chorioamnionitis is rare. Management according to the EOS calculator would markedly reduce the potential complications of antibiotic use. These data should initiate re-examination of existing protocols for management of this cohort of patients.