Aim Effective treatment of neonatal infection can be life-saving, but is increasingly limited by the development of resistant organisms. Antimicrobial stewardship is therefore important, to optimally select antimicrobial treatments that have a targeted spectrum, and suitable duration. This should result in the best clinical outcome and minimise impact on subsequent resistance. We audited the use of antibiotics for episodes of suspected Early (<72 h) and Late onset sepsis (> 72 h) on a local neonatal unit.
Method Data was collected prospectively for 68 episodes (66 patients) of antibiotic prescribing in our NICU over a one month period in June 2015. We looked at indications to initiate/change antibiotics, and also choice and duration of antibiotic treatment. We examined the results of blood cultures, and whether cultures were taken before initiating/changing antibiotics.
Results 61 episodes of suspected Early onset sepsis were noted. All were treated with Benzylpenicillin and Gentamicin (as per local guidelines and national recommendation1) 46/61 (67%) episodes received less than 5 days of antibiotics. 7 episodes of suspected Late onset sepsis were noted. 6/7 (86%) episodes were treated with Flucloxacillin/Gentamicin or Tazocin/Vancomycin as per local guidelines. The most common indications for antibiotics were respiratory distress and temperature instability. 4/7 (57%) episodes had positive growth on blood culture, with antibiotics changed based on the results. 4/7 (57%) episodes received less than 5 days antibiotics. Blood cultures were repeated when antibiotics were changed in all but one episode.
Conclusion Indications and choices of antibiotics were almost always in keeping with local guidelines, with appropriate optimisation of antibiotics following review of blood cultures. However, there were several delays in stopping antibiotics, contrary to national guidance.2 Clear documentation of daily antibiotic review should be implemented in order to further improve antibiotic stewardship.
Vergnano S, Menson E, Kennea N, et al. Neonatal infections in England: the NeonIN surveillance network. Arch Dis Child Fetal Neonatal Ed. 2011;96:F9–14
National Institute for Health and Clinical Excellence: Antibiotics for early-onset neonatal infection. CG149. London: National Institute for Health and Clinical Excellence, 2012
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