Variations in Antibiotic Use and Sepsis Management in Neonatal Intensive Care Units: A European Survey

Abstract

Management of neonatal sepsis and the use of antimicrobials have an important impact on morbidity and mortality. However, there is no recent background on which antibiotic regimens are used in different European neonatal intensive care units (NICUs). Our study aimed to describe the use of antibiotics and other aspects of early- and late-onset sepsis (EOS and LOS, respectively) management by European NICUs. We conducted an online survey among NICUs throughout Europe to collect information about antibiotic stewardship, antibiotic regimens, and general aspects of managing neonatal infections. NICUs from up to 38 European countries responded, with 271 valid responses. Most units had written clinical guidelines for EOS (92.2%) and LOS (81.1%) management. For EOS, ampicillin, penicillin, gentamicin, and amikacin were the most commonly used antibiotics. Analysis of the combinations of EOS regimens showed that the most frequently used was ampicillin plus gentamicin (54.6%). For LOS, the most frequently used antibiotics were vancomycin (52.4%), gentamicin (33.9%), cefotaxime (28%), and meropenem (15.5%). Other aspects of the general management of sepsis have also been analyzed. The management of neonatal sepsis in European NICUs is diverse. There was high self-reported adherence to the local clinical guidelines. There was homogeneity in the combination of antibiotics in EOS but less in LOS.

Prescription of Aminoglycosides in 23 French Neonatal Intensive Care Units

“…These results about GENT and AMK prescribing are consistent with a recent European survey of antibiotics protocols used in 271 NW [ 2 ]. Protocols for antibiotics treatments were related to early-onset neonatal infection, late-onset neonatal infection, and necrotizing enterocolitis.…”

“…Protocols for antibiotics treatments were related to early-onset neonatal infection, late-onset neonatal infection, and necrotizing enterocolitis. GENT and AMK were the aminoglycosides prescribed in 98% of protocols, the remaining percentage being provided by tobramycin [ 2 ] as in this study. More generally, the leading position of GENT is widely recognized, but the rank of AMK varies according to studies.…”

“…Globally, results from literature and our own research show that neonatologists mostly choose GENT, especially in early-onset neonatal infections [ 2 ].…”

“…Antibiotics are also the most prescribed medications in neonatal wards (NW) [ 1 , 2 , 3 ]. Gentamicin (GENT) is the leading aminoglycoside, ranking as the 1st or 2nd most prescribed drug in the neonatal intensive care unit (NICU).…”

“…Gentamicin (GENT) is the leading aminoglycoside, ranking as the 1st or 2nd most prescribed drug in the neonatal intensive care unit (NICU). Amikacin (AMK) has been reported as the 2nd most prescribed aminoglycoside in France and Europe [ 1 , 2 , 3 ].…”