Sanne Hoeks

General Discussion 115 7 Diagnostic algorithm Sepsis is a syndrome that is a result from the complex interplay between an infectious trigger and the host response. Accordingly, diagnosis and prognosis including stratifying patients for personalized treatment requires in addition to the identification of the causative agent the corresponding determination of the host response. This data has so far been unused in the diagnostic algorithms. The use of an EOS calculator resulted in a decrease in blood culture use and empirical antibiotic administration from 14.5 to 4.9% and 5.0 to 2.6%, respectively, without apparent negative effects. 76 Clinical decision algorithms can also be used to evaluate the effectiveness and safety of withholding antibiotics in specific subgroups, 76 which could include those who appear to be well at the time of assessment or who only have a low-grade fever. 77, 78 While individual interleukins showed reasonable sensitivities and specificities, the combination of several markers was shown to be superior in several studies. 79 This observation potentiates a personalized diagnostics approach by strategies of both protein levels, gene expression data from NGS and a combination of the two data types. This approach will have the power to alleviate the severe problem of early recognition of septic neonates, and will be particularly useful in assessing the immune response patterns of the neonatal patients and providing thus clues on the infectious or non-infectious nature of the inflammation.