Antimicrobial usage and its quantification for neonatal sepsis at a tertiary care hospital neonatal intensive care unit

Manjari Kumari; Suparna Chatterjee; Tapas Som; Pinaki Chattopadhyay

doi:10.18203/2319-2003.ijbcp20194114

Authors

Manjari Kumari Department of Pharmacology, Rajshree Medical Research Institute, Bareilly, Uttar Pradesh, India
Suparna Chatterjee Department of Pharmacology, Institute of Postgraduate Medical Education & Research , Kolkata, West Bengal, India
Tapas Som Department of Neonatology, All India Institute of Medical Sciences Bhubaneswar, Odisha, India
Pinaki Chattopadhyay Department of Neonatal Microbiology, Institute of Postgraduate Medical Education & Research and SSKM Hospital Kolkata, West Bengal, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20194114

Keywords:

Antimicrobials, Antibiotic usage, Days of therapy, Neonatal sepsis, Neonatal intensive care unit

Abstract

Background: Antimicrobial therapy for neonatal sepsis is challenging as its judicious use can save neonates while its inappropriate use can lead to rapid emergence of resistant strains. Quantification of consumption of antimicrobial agents (AMA) has not been undertaken in Indian neonatal intensive care units (NICU) setting. This prospective observational study evaluated the antimicrobial prescribing pattern and quantified its consumption in clinically suspected neonatal sepsis (NS) cases.

Methods: Clinically suspected NS cases admitted over study period of 18 months in a tertiary care level III NICU were enrolled. Data of antimicrobials prescribed, its consumption, culture sensitivity profile of organisms isolated were collected.Consumption was quantified by computing the days of therapy (DOT) per 1000 patient-days (PD).

Results: 150 clinically suspected NS cases were enrolled; 37.33% were culture positive. The most common AMA prescribed were netilmicin (94.67%), piperacillin-tazobactam (88.67%). Only 0.67% cases received reserve antimicrobials like colistin, vancomycin and linezolid. 58% received 2 AMA, 39.33% received ≥3 agents. Total antimicrobial consumption was 614.86 DOT/1000 PD and 21.68 DOT/ neonate. Statistically significant difference in total AMA consumption amongst culture positive versus negative cases (p <0.001) was observed but difference was not significant in EOS versus LOS (p=0.95).

Conclusion: Usage of antimicrobials for neonatal sepsis was guided by sensitivity pattern of local prevalent flora and clinical response. Usage of reserve antimicrobials were restricted. However, consumption of AB was higher compared to developed countries and we intend to use the study outcome data for antibiotic stewardship program to reduce antibiotic consumption and modify prescribing trends at the study setting.

Metrics

Metrics Loading ...

References

Report of the National Neonatal Perinatal Database (National Neonatology Forum). 2002-03; 1-13.

Thaver D, Zaidi AK. Burden of neonatal infections in developing countries: a review of evidence from community-based studies. Pediatric Infectious Dis J. 2009 Jan 1;28(1):S3-9.

Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD. Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet. 1999;354(9194):1955-61.

Stoll BJ. The global impact of neonatal infection. Clin Perinatol. 1997;24(1):1-21.

Clark RH, Bloom BT, Spitzer AR, Gerstmann DR. Reported medication use in the neonatal intensive care unit: data from a large national data set. Pediatr. 2006;117(6):1979-87.

Cantey JB, Wozniak PS, Sánchez PJ. Prospective surveillance of antibiotic use in the neonatal intensive care unit: results from the SCOUT study. Pediatr Infect Dis J. 2015;34(3):267-72.

Cantey JB, Sánchez PJ. Prolonged antibiotic therapy for culture-negative sepsis in preterm infants: it’s time to stop. J Pediatr. 2011;159(5):707-8.

Ibrahim OM, Polk RE. Antimicrobial use metrics and benchmarking to improve stewardship outcomes: methodology, opportunities, and challenges. Infect Dis Clin North Am. 2014;28(2):195-214.

Van der Meer JW, Gyssens IC. Quality of antimicrobial drug prescription in hospital. Clin Microbiol Infect. 2001;6:12-5.

Society for Healthcare Epidemiology of America, Infectious Diseases Society of America, Pediatric Infectious Diseases Society. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol. 2012;33(4):322-7.

Neubert A, Lukas K, Leis T, Dormann H, Brune K, Rascher W. Drug utilisation on a preterm and neonatal intensive care unit in Germany: a prospective, cohort-based analysis. Eur J Clin Pharmacol. 2010;66(1):87-95.

Suryawanshi S, Pandit V, Suryawanshi P, Panditrao A. Antibiotic Prescribing Pattern in a Tertiary Level Neonatal Intensive Care Unit. J Clin Diagn Res. 2015;9(11):21-4.

Bansal D, Mangla S, Undela K, Gudala K, D’Cruz S, Sachdev A, et al. Measurement of adult antimicrobial drug use in tertiary care hospital using defined daily dose and days of therapy. Indian J Pharm Sci. 2014;76(3):211-7.

Cantey JB, Wozniak PS, Pruszynski JE, Sánchez PJ. Reducing unnecessary antibiotic use in the neonatal intensive care unit (SCOUT): a prospective interrupted time-series study. Lancet Infect Dis. 2016;16(10):1178-84.

Fischer JE. Physicians’ ability to diagnose sepsis in newborns and critically ill children. Pediatr Crit Care Med. 2005;6(3):120-5.

Bekhof J, Reitsma JB, Kok JH, Van Straaten IHLM. Clinical signs to identify late-onset sepsis in preterm infants. Eur J Pediatr. 2013;172(4):501-8.

Escobar GJ, Puopolo KM, Wi S, Turk BJ, Kuzniewicz MW, Walsh EM, et al. Stratification of risk of early-onset sepsis in newborns ≥ 34 weeks’ gestation. Pediatrics. 2014;133(1):30-6.

Patel SJ, Oshodi A, Prasad P, Delamora P, Larson E, Zaoutis T, et al. Antibiotic use in neonatal intensive care units and adherence with Centers for Disease Control and Prevention 12 Step Campaign to Prevent Antimicrobial Resistance. Pediatr Infect Dis J. 2009;28(12):1047-51.

Shipp K, Chiang T, Karasick S, Quick K, Nguyen S, Cantey J. Antibiotic Stewardship Challenges in a Referral Neonatal Intensive Care Unit. Am J Perinatol. 2016;33(5):518-24.

Jardine MA, Kumar Y, Kausalya S, Harigopal S, Wong J, Shivaram A, et al. Reducing antibiotic use on the neonatal unit by improving communication of blood culture results: a completed audit cycle. Arch Dis Child Fetal Neonatal Ed. 2003;88(3):255.

Marwah P, Chawla D, Chander J, Guglani V, Marwah A. Bacteriological profile of neonatal sepsis in a tertiary-care hospital of Northern India. Indian Pediatr. 2015;52(2):158-9.

Muley VA, Ghadage DP, Bhore AV. Bacteriological Profile of Neonatal Septicemia in a Tertiary Care Hospital from Western India. J Glob Infect Dis. 2015;7(2):75-7.