Empirical use of antibiotic therapy in the prevention of early onset sepsis in neonates: a pilot study

Abstract

Introduction: To identify and assess the characteristics, risk and outcome of neonates treated with empiric antibiotics for suspected early onset sepsis (EOS).

Material and methods: This is a retrospective study conducted at a Malaysian government hospital. Records of neonatal patients admitted within 72 h of life and prescribed with empirical antibiotic therapy for suspected EOS were reviewed.

Results: Three hundred and twenty-three cases met the inclusion criteria and were divided into gestational age (premature < 36 weeks; term ≥ 37 weeks) and birth weight (low birth weight (LBW) < 2.5 kg; normal body weight (NBW) ≥ 2.5 kg) groups. Premature (n = 197) and LBW (n = 194) neonates required significantly longer hospital stay, a higher degree of ventilator support and more surfactant (p = 0.001). More than 90.0% of premature and LBW neonates were diagnosed with respiratory distress syndrome, congenital pneumonia and presumed sepsis. Term (n = 123) and NBW (n = 129) neonates had greater maternal risk factors, especially meconium-stained amniotic fluid (MSAF) and perinatal asphyxia. The incidence of demonstrated EOS was 3.1%. Crystalline penicillin plus gentamicin was the standard therapy for all groups and was started within 24 h of life, with a mean treatment duration of ∼4 days. The treatment success rate was 89.0%, and only LBW neonates showed a higher risk of overall treatment failure (OR = 3.75; 95% CI: 1.22-11.53). Seventy-four percent of term and NBW neonates discharged well, while 42.0% of premature and LBW neonates required referral.

Conclusions: Crystalline penicillin plus gentamicin prescribed within 24 h of life is effective in the prevention of EOS. However, low birth weight neonates have a higher risk of treatment failure.

Keywords: clinical outcome; gentamicin; healthcare-associated infection; intensive care; newborn; pediatrics; penicillin.

Figure 1

Study outline and exclusion

Figure 2

Forest plot of clinical manifestation The data are presented as odds ratio (OR) (indicated by diamonds) with the 95% CI (indicated by lines). Odds ratio of the full term and normal BW is 0; shift to the left of this line indicates lower risk in premature and low BW and vice versa.

Figure 3

Forest plot of treatment failure (changes of antibiotic within 72 h) The data are presented as odds ratio (OR) (indicated by diamonds) with the 95% CI (indicated by lines). Odds ratio of the full term and normal BW is 0; shift to the left of this line indicates lower risk in premature and low BW and vice versa.