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Abstract

Objective: Neonatal sepsis continues to be a major cause of morbidity and mortality globally, particularly in developing countries. The rising rate of antimicrobial resistance underscores the urgent need for reliable, practical sepsis prediction tools to optimize antibiotic use. The Sepsis Prediction Score (SPS) integrates clinical and laboratory parameters and has shown a positive impact in simplifying clinical decision-making. This study aimed to evaluate the diagnostic accuracy of the SPS in predicting late-onset sepsis (LOS) in a tertiary referral hospital in Indonesia. Methods: This diagnostic study used a cross-sectional design and was conducted at Dr. Kariadi General Hospital, using medical records and microbiology laboratory data from June 2023 to May 2024. Neonates aged 3–28 days with at least one risk factor for LOS and available culture results were included. The performance of the SPS was analyzed using receiver operating characteristic (ROC) curves, and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: Of 430 neonates with suspected LOS, 154 met the inclusion criteria, and 137 were included in the final analysis. Culture-proven sepsis was identified in 32.8% of subjects. ROC analysis demonstrated an area under the curve of 0.82 (95% CI: 0.75–0.90). An SPS cut-off score of ≥3 provided a sensitivity of 78%, specificity of 79%, PPV of 65%, and NPV of 88%. Subgroup analysis consistently demonstrated strong diagnostic performance across categories such as birth weight, gestational age, and delivery method. Conclusion: The SPS is a valid, sensitive, and specific tool for predicting late-onset sepsis and helps promote more rational antibiotic use. Its application and feasibility in clinical practice could enhance sepsis management and contribute to antimicrobial stewardship efforts, particularly in resource-limited settings. Prospective and quality improvement studies are required further to evaluate its impact on antibiotic use and neonatal outcomes.

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JPID_21_3_2 - Supplementary Table.docx (33 kB)
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