TY - JOUR
T1 - Early-onset neonatal sepsis and antibiotic use in Indonesia
T2 - a descriptive, cross-sectional study
AU - Salsabila, Khansa
AU - Toha, Nadira Mohammad Ali
AU - Rundjan, Lily
AU - Pattanittum, Porjai
AU - Sirikarn, Prapassara
AU - Rohsiswatmo, Rinawati
AU - Wandita, Setya
AU - Hakimi, Mohammad
AU - Lumbiganon, Pagakrong
AU - Green, Sally
AU - Turner, Tari
N1 - Funding Information:
SEA-URCHIN was funded by a Project Grant from the National Health and Medical Research Council of Australia (No. 1004005). The funding body had no role in the design of the study and collection, analysis, and interpretation of data or in writing the manuscript.
Funding Information:
We wish to thank the SEA-URCHIN Study Group for enabling this research. Project Investigators: Pagakrong Lumbiganon, Malinee Laopaiboon and Pisake Lumbiganon (Khon Kaen University, Thailand); Jacinto Blas III Mantaring and Resti Bautista (University of Philippines Manila); Hasmawati Hassan (Hospital Raja Perempuan Zainab II, Malaysia); Setya Wandita and Mohammad Hakimi (Gadjah Mada University, Indonesia); Rinawati Rohsiswatmo (Cipto Mangunkusumo Hospital, Indonesia); Sally Green, Steve McDonald and Joanne McKenzie (Monash University, Australia); Caroline Crowther (University of Auckland, New Zealand). Project Coordinators: Violet Marion (Monash University, Australia). Project Administrators: Melissa Murano (Monash University, Australia). Statisticians: Malinee Laopaiboon and Porjai Pattanitum (Khon Kaen University, Thailand). Senior Research Fellows: Tari Turner and Gabriella Tikellis (Monash University, Australia).
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - 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.
AB - 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.
KW - Antibiotic use
KW - Early-onset sepsis
KW - Indonesia
KW - Neonate
UR - http://www.scopus.com/inward/record.url?scp=85130170418&partnerID=8YFLogxK
U2 - 10.1186/s12889-022-13343-1
DO - 10.1186/s12889-022-13343-1
M3 - Article
C2 - 35581620
AN - SCOPUS:85130170418
SN - 1471-2458
VL - 22
JO - BMC Public Health
JF - BMC Public Health
IS - 1
M1 - 992
ER -
