Neonatal Med.  2016 Nov;23(4):198-202. 10.5385/nm.2016.23.4.198.

Restricted Usage of Prophylactic Antibiotics in Extremely Low Birth Weight Infants for Early-Onset Sepsis as Quality Improvement Program

• Shin SH
• Kim HW
• Jung YH
• Shin SH
• Kim EK
• Kim HS

• KMID: 2360458
• DOI: http://doi.org/10.5385/nm.2016.23.4.198

Abstract

PURPOSE
The prevalence of antibiotics resistant bacterial infection among preterm infants has been increased due to indeliberate use of prophylactic broad spectrum antibiotics. The objective of this study was to assess the effectiveness of restricted usage of prophylactic antibiotics by comparing the incidence of culture proven early onset sepsis (EOS).
METHODS
This was a retrospective cohort study for extremely low birth weight infants who were born in Seoul National University Children's Hospital during 2009-2014. The groups were divided into two periods, from 2009 to 2011 (period I) and from 2012 to 2014 (period II) based on the implementation on quality improvement activity since 2012. The indication of prophylactic antibiotics were; 1) umbilical vein catheter (UVC) insertion for resuscitation in delivery room, 2) prolonged preterm premature rupture of membrane >18 hours, 3) maternal fever during labor or sustained septic amniotic fluid. The incidence of EOS and the rate of empirical antibiotics usage were compared between two periods.
RESULTS
A total of 245 infants were admitted to the neonatal intensive care unit during the study period. Baseline demographics and clinical characteristics were similar between two periods except UVC insertion rate. The rate of empirical antibiotics usage significantly decreased in period II (71.1% for period I vs. 56.4% for period 2, P=0.022). Incidence of EOS was not different between two periods whether prophylactic antibiotics use or not.
CONCLUSION
Quality improvement for reducing prophylactic antibiotics use may be effective to reduce a use of antibiotics without increasing EOS.

Keyword

Neonatal sepsis; Prophylactic antibiotics; Quality improvement

MeSH Terms

Amniotic Fluid
Anti-Bacterial Agents*
Bacterial Infections
Catheters
Cohort Studies
Delivery Rooms
Demography
Female
Fever
Humans
Incidence
Infant*
Infant, Low Birth Weight*
Infant, Newborn
Infant, Premature
Intensive Care, Neonatal
Membranes
Prevalence
Quality Improvement*
Resuscitation
Retrospective Studies
Rupture
Seoul
Sepsis*
Umbilical Veins
Anti-Bacterial Agents