Prescription of antibiotics in a neonatal intensive care unit

Two in three neonates in intensive care units are treated with antibiotics. However, the extensive use of wide spectrum antibiotics increases the emergence of multiresistant bacteria.

Aim

To study the use of antibiotics in a neonatal intensive care unit.

Methods

All neonates receiving antibiotic treatment over a 6 month period were included in this prospective study. The information gathered included the indications and criteria for initiating antibiotic therapy (clinical, biological and bacteriological), duration of treatment and the reasons for withdrawal of treatment. The prescription/written procedures correlation was judged a posteriori by a non-prescribing physician.

Results

One hundred and thirty-five infants were included, of whom eight received several courses (2–5 courses) at different times. Mean gestational age was 33.5 weeks (24.5–41.5 weeks). In 82% of cases admission was for respiratory distress. The main indications for antibiotic treatment were 1) primary infection (78%, of which 92.4% were for suspected feto-maternal infection), 2) nosocomial infection (17% of which occurred in neonates born at less than 28 weeks' GA and hospitalized in the unit for more than 21 days) and 3) post-operative prophylaxis (5%). Clinical criteria predominated in the primary infections but in 62% of cases feto-maternal infection was not confirmed, justifying withdrawal of treatment after 3 days. Bacteriological criteria played a part in the treatment decision only in nosocomial infections (14/23 newborns). Infringement of treatment guidelines represented 9% of infants treated and mainly involved length of treatment.

Conclusion

These results show that 1) the majority of antibiotic treatments for suspected feto-maternal infection were unconfirmed, demonstrating the need to refine the criteria for diagnosis, 2) the level of nosocomial infection was low and mainly occurred in very premature infants (7–30% in the literature) and 3) the fewer than 10% infringements of guidelines emphasized the value of continuous surveillance of use of antibiotics in neonatal intensive care units.