Antimicrobials utilization and outcomes of neonatal sepsis among patients admitted to a University Teaching Hospital in Malaysia
Antimicrobials utilization and outcomes of neonatal sepsis among patients admitted to a University Teaching Hospital in Malaysia
Abstract. Neonatal sepsis is one of the most common reasons for admission to neonatal units in developing countries and it remains a significant cause of neonatal morbidity and mortality. Antimicrobial treatment of patients with sepsis is often predicated on the general principles of appropriate drug use and information extrapolated from other populations, rather than on evidence-based recommendations specific to these patients. Limited information is available about antibiotics use among neonates with suspected or confirmed sepsis in Malaysia and many regions of the world. This study aimed to explore and describe the clinical characteristics of neonatal sepsis; current pattern of antimicrobial use; the clinical outcomes of neonatal sepsis management; and to estimate the acquisition costs of the most commonly used antimicrobial regimens in the management of the condition. We retrospectively reviewed all cases of neonates admitted with sepsis to the Neonatal Intensive Care Unit (NICU) of Hospital Universiti Sains Malaysia; a university-based teaching hospital for one year. Both descriptive and inferential statistics were used for data analysis where appropriate. Of the 121 neonates included in the study, 89 (73.6%) presented with various risk factors for sepsis prior to or at the time of diagnosis and maternal risk factor was the highest reported (37.2%). About 26% of the neonates had positive culture and sensitivity tests. Of these, methicillin-resistant Staphylococcus aureus (MRSA) constituted the most prevalent microbial isolate (22.5%). All the patients received some form of empiric antibiotic therapy and crystalline penicillin G plus gentamicin regimen was the most commonly prescribed empiric therapy (69.4%). There was about 9-fold difference between the acquisition costs of the most widely and the second most widely used regimen (RM 29.32 per patient vs. RM 264.74 per patient). Four patients (3.3%) died during hospitalization in the NICU and 107 (88.4 %) were discharged clinically stable. Early treatment of neonatal sepsis with broad-spectrum antibiotics based on presenting signs and symptoms and clinical history had produced good clinical outcomes. This study has an important implication on guiding policy for developing comprehensive, evidence-based practice guidelines, adherence to which may lead to improved rational antibiotics use, costs reduction and improvement of overall care of patients with neonatal sepsis. Key words: Neonatal sepsis; clinical characteristics; antibiotics utilization; NICU
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- Klein JO, Mercy SM. Bacterial Sepsis disease and meningitis. In Remington JS, Klein JO, eds. Infectious diseases of the fetus and newborn infants. Philadelphia: Saunders, 1990: 601- 656.
- Paul VK, Singh M. Neonatal Sepsis. In: Singh M (ed). Medical Emergencies in Children. 2nd edn. New Delhi: Sagar Publication, 1995: pp 115.
- Polin RA. The “Ins and Outs” of Neonatal Sepsis. The J of pediatrics 2003; 143: 3-4.
- Escobar GJ. The neonatal “sepsis work - up”: Personal reflections on the development of an evidence - based approach toward newborn infections in a managed care organization. Pediatrics 1999; 103: 360-373.
- Jaswal RS, Kaushal RK, Goel A. et al. Role of C - reactive protein in deciding duration of antibiotic therapy in neonatal septicemia. Indian Pediatrics 2003; 40: 880 - 883.
- Dowodu A, Al-Umran K, Twun-Danso K. A case control study of neonatal sepsis: experience from Saudi Arabia. J Trop Pediatr 1997; 43: 84-88.
- Fish DN. Optimal Antimicrobial therapy for sepsis. Am J Health - Syst Pharm 2002; 59: S13- 19.
- Bochud PY, Glauser MP, Calandra T. Antibiotics in sepsis. Intensive Care Med. 2001; 27: S33 – 48.
- Simon D, Tranholma G. Antibiotic selection for patients with septic shock. Crit Care Clin. 2000; 16: 215-231.
- Kollef MH, Sherma G, Ward S. Inadequate antimicrobial treatment of infection. Chest 1999; 115: 462-474.
- Anwar SK, Mustafa S, Pariyani S, Ashraf S, Taufiq KM. Neonatal sepsis: an etiological study. J Pak. Med Assoc 2000; 50 (3): 91-94.
- Singh SA, Dutta S, Narang A. Predictive clinical scores for diagnosis of late onset neonatal septicemia. J Trop Pediatr 2003; 49: 235-239.
- Fanaroff A, Sheldon B, Wright LL, et al. Incidence, presenting feature, risk factors, and significance of late onset septicemia. Pediatr Infect Dis J 1998; 17: 593-598.
- Gerdes JS, Polin R. Early diagnosis and treatment of neonatal sepsis. Ind J Pediatr 1998; 65: 63 - 78.
- Aggarwal R, Sarkar N, Deorari AK, Paul VK. Sepsis in the newborn. Indian J Pediatr 2001; 68:1143-1147.
- Squire E, Favara B, Todd J. Diagnosis of neonatal bacterial infection: hematologic and pathologic findings in fatal and non - fatal cases. Ped 1979; 64: 60-65.
- Davies PA and Gothefors LA. Bacterial infections in the fetus and newborn. Philadelphia, WB Saunders, 1984.
- Kuruvilla KA, Pillai S, Jesudason M, Jana AK. Bacterial profile of sepsis in a neonatal unit in south India. Indian Pediatr 1998; 35: 851 - 858.
- Ronnestad A, Abrahamsen TG, Gaustad P, Finne PH. Blood culture isolates during 6 years in a tertiary neonatal intensive care unit. Scand J Infect Dis. 1998; 30: 245-51.
- Baek YW, Brokat S, Padbury JF et al. Inter - α inhibitor proteins in infants and decreased levels in neonatal sepsis. J. Pediatr 2003; 143: 11-15.
- Benitz WE. Serial serum C – reactive protein determinations in the diagnosis of neonatal infections. Pediatrics 1998; 102: E41 - 55.
- Dollner V, Austgulen H, Vatten L, Austgulen R. (2001) Early diagnostic markers for neonatal sepsis: comparing C-reactive protein, interleukin- 6, soluble tumour necrosis factor receptors and soluble adhesion molecules. J Clin Epidemiol. 2001; 54: 1251-1257.
- Pulliam PN, Attia MW, Cronan KM. C - reactive protein in febrile children 1 - 36 months of age with clinically undetectable serious bacterial infection. Pediatrics 2001; 108: 1275 - 1279.
- Yurdokok M. Antibiotics use in neonatal sepsis. Turk J Pediatr 1998; 40: 17-33.
- Orrett FA, Shurland SM. Neonatal sepsis and mortality in a regional hospital in Trinidad: aetiology and risk factors. Ann Trop Paediatr 2001; 21: 20-36.
- Guidelines on Rational Antibiotic Utilisation in Selected Paediatric Conditions, Ministry of Health, Malaysia 2004.
- Edwards MS. Q & A: Antibiotic Therapy of neonates with bacterial sepsis. Ped Infect Dis Journal 1995; 14: 166-167.
- Klepser DG. Pitfalls associated with commonly used methods for Pharmacoeconomic analyses. Pharmacotherapy 2002; 22: 35S-38S.
- ISSN: 1301-0883
- Başlangıç: 1996
- Yayıncı: ERBİL KARAMAN
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