Early-onset neonatal sepsis and antibiotic use in Indonesia: a descriptive, cross-sectional study

Abstract

Background Early diagnosis and prompt antibiotic treatment are crucial to reducing morbidity and mortality of early-onset sepsis (EOS) in neonates. However, this strategy remains challenging due to non-specific clinical findings and limited facilities. Inappropriate antibiotics use is associated with ineffective therapy and adverse outcomes. This study aims to determine the characteristics of EOS and use of antibiotics in the neonatal-intensive care units (NICUs) in Indonesia, informing efforts to drive improvements in the prevention, diagnosis, and treatment of EOS. Methods A descriptive study was conducted based on pre-intervention data of the South East Asia-Using Research for Change in Hospital-acquired Infection in Neonates project. Our study population consisted of neonates admitted within 72 h of life to the three participating NICUs. Neonates who presented with three or more clinical signs or laboratory results consistent with sepsis and who received antibiotics for 5 consecutive days were considered to have EOS. Culture-proven EOS was defined as positive blood or cerebrospinal fluid culture. Type and duration of antibiotics used were also documented. Results Of 2,509 neonates, 242 cases were suspected of having EOS (9.6%) with culture-proven sepsis in 83 cases (5.0% of neonatal admissions in hospitals with culture facilities). The causative organisms were mostly gram-negative bacteria (85/94; 90.4%). Ampicillin / amoxicillin and amikacin were the most frequently prescribed antibiotics in hospitals with culture facilities, while a third-generation cephalosporin was mostly administered in hospital without culture facilities. The median durations of antibiotic therapy were 19 and 9 days in culture-proven and culture-negative EOS groups, respectively. Conclusions The overall incidence of EOS and culture-proven EOS was high in Indonesia, with diverse and prolonged use of antibiotics. Prospective antibiotic surveillance and stewardship interventions are required.

Breast problems and associated factors among lactating women in Northeast Ethiopia, 2022

“…Women with preterm infants had higher odds of developing breast problems compared to mothers with term infants. This finding is supported by a study conducted in Texas 27 . This difference might be due to restrictions on mother-infant continuous contact in neonatal intensive care units, as well as delays in discharge and limited contact with the mother after overcoming complications such as intraventricular hemorrhage and necrotizing enterocolitis.…”

Prevalence and determinants of early onset neonatal sepsis at two selected public referral hospitals in the Northwest Ethiopia: a cross-sectional study

“…This conclusion was consistent with a study conducted in Dil Chora Referral Hospital, Eastern, Ethiopia [ 32 ]and South Sinai, Egypt [ 33 ] which found that the prevalence of early onset neonatal sepsis in neonatal intensive care units was 40.5% and 31.8% respectively. Early onset neonatal sepsis (EONS) was found to be higher than studies conducted in Indonesia 26.6% [ 34 ] and in India 20.9% [ 35 ], in hospitals of Wolaita Sodo Town 26.9% [ 36 ]. The primary cause of the disparity could be differences in sociodemographic factors.…”

Pattern of Antimicrobial Susceptibility and Antimicrobial Treatment of Neonates Admitted with Suspected Sepsis in a Teaching Hospital in Ghana, 2021

“…Thus, interpreting the clinical significance of these isolates can be challenging for physicians [27]. In contrast, Gram-negative bacteria were the predominant organisms isolated in similar studies elsewhere in South Asia [4,28]. Furthermore, Gram-negative infections have been associated with significantly greater morbidity and mortality in neonates and widespread AMR [4].…”