An Audit of Antibiotic Usage among Neonates in a Neonatal Intensive Care Unit: A Prospective Observational Study

Abstract

Introduction: Antibiotics are used frequently in the Neonatal Intensive Care Unit (NICU). Evaluating the antibiotic usage pattern at institutional or unit level would help in preventing antibiotic overuse and antibiotic resistance. Aim: To assess antimicrobial usage among neonates admitted to the NICU. Materials and Methods: The study was a prospective observational study done in the level III NICU at Hyderabad, India. All the antibiotics used among infants admitted to the NICU from January 2019 to December 2019 were monitored. Data collected were entered in Microsoft Office Excel 2016 and analysed using OpenEpi Version 3. Student t-test for continuous variables and chi-square test for dichotomous variables was used. Results: A total of 986 infants were admitted to the NICU during the study period. Antimicrobials were prescribed in 322 (32%) infants. Antibiotics were most frequently prescribed in symptomatic infants (48%) for suspected sepsis. Amikacin was prescribed most frequently in 74% of infants. Cephalosporin was prescribed only in 8.9% cases. Blood culture positivity rate was 28%. Antibiotics were stopped only in 40% of the infants after the receipt of a negative blood culture report. Conclusion: In this study, 68% of the infants were managed without any exposure to antibiotics. Half of the antibiotic usage was in suspected infection cases and antibiotics were continued in majority of cases with negative blood culture report. These clinical scenarios are amenable to antibiotic stewardship strategies in reducing antibiotic usage. Cephalosporin usage can be minimised with proper antibiotic usage guidelines.

Keywords

• antimicrobial resistance
• antimicrobial stewardship
• neonates