QUALITATIVE REVIEW OF ANTIBIOTIC USE FOR NEONATAL SEPSIS
Objective: The aim of this study is to evaluate the antibiotic use in neonates with sepsis.
Methods: An observational retrospective study was conducted using medical records of neonates diagnosed with early-/late-onset sepsis who were
prescribed antibiotics and who were treated in the neonatal intensive care unit (NICU) at the Dr. Cipto Mangunkusumo Hospital between January 1 and
December 31, 2015. Patient records were screened for antibiotic use; qualitative analyses were performed using the Gyssens algorithm. Concordance
of empirical antibiotic prescriptions with subsequent blood culture and sensitivity tests was evaluated.
Results: A total of 176 sepsis cases included 80 and 96 neonates with normal and low birth weights (LBWs), respectively. Ampicillinsulbactam+
gentamycin, which is indicated in local guidelines as the first-line antibiotic combination for neonatal sepsis, was most frequently
prescribed. In the normal birth weight group, appropriate antibiotic use (Gyssens Category I) was found in 89.7% of cases, whereas Gyssens Category V
(no indication) was found in 4.54% of cases. In the LBW group, 88.1% and 6.2% of cases were included in Gyssens Categories I and V, respectively.
Only 17.5% and 13.5% cultured blood specimens from normal and LBW groups, respectively, yielded positive results; the most commonly identified
bacteria were Acinetobacter baumannii and Klebsiella pneumonia. All isolates were resistant to ampicillin-sulbactam; only 7.4% were sensitive to
Conclusion: Antibiotic use for neonatal sepsis in NICU in this study can be considered appropriate, suggesting proper implementation of antimicrobial
guidelines. However, high rates of resistance to the first-line antibiotics for neonatal sepsis are concerning.
the perinatology room. Sari Pediatr 2011;12:381-5.
2. Putra PJ. Incidents and factors associated with neonate sepsis at Sanglah
hospital Denpasar. Sari Pediatr 2012;14:205-10.
3. Lever A, Mackenzie I. Sepsis: Definition, epidemiology, and diagnosis.
4. Nia SS, Modaresahmadi S, Thirumoorthi V, Anwar Q, Prasad S.
Multidrug-resistant polymicrobial bacteremia and sepsis: A rare case
report. Asian J Pharm Clin Res 2018;11:5-8.
5. Sheth KV, Patel TK, Tripathi CB. Antibiotic sensitivity pattern in
neonatal intensive care unit of a tertiary care hospital of India. Asian J
Pharm Clin Res 2012;5:46-50.
6. Ahmed A, Lutfi S, Hail MA, Sadi MA. Antibiotic susceptibility patterns
of microbial isolates from blood culture in the neonatal intensive care
unit of Hamad medical corporation (HMC), Doha, Qatar. Asian J Pharm
Clin Res 2013;6:191-5.
7. Mangunkusumo C. National Hospital the Clinical Practice Guidelines
of the Department of Pediatrics. Jakarta: National Hospital; 2015.
8. Royal Womenâ€™s Hospital. Neonatal Pharmacopoeia. 2nd ed. Melbourne:
Pharmacy Department the Royal Womenâ€™s Hospital; 2013.
9. Shann F, editor. Drug Doses. 16th ed. Victoria, Australia: Royal
Childrenâ€™s Hospital Parkville; 2014.
10. Satari HI, Firmansyah A, Theresia T, Qualitative evaluation of antibiotic
usage in pediatric patients. Pediatr Indones 2011;51:303-10.
11. Pamela DS. Qualitative Evaluation of Antibiotics Usage with Gyssens
Method in Class 3 Infection Ward, Departement of Child Health,
Dr. Cipto Mangunkusumo Hospital, Prospectively. Thesis. Jakarta:
Universitas Indonesia; 2011.