Empirical Antibiotics Protocol for Neonatal Sepsis in Cipto Mangunkusumo Hospital

Background : Substandard infection control, irrational use of antibiotic, and poor surveillance could lead to high number of neonatal infection rate as well as multi drug resistance (MDR) organisms and mortality. Empirical antibiotic guideline for early onset sepsis (EOS) in our unit includes ampicillin plus gentamicin for mild clinical features and ampicillin-sulbactam plus gentamicin for severe clinical manifestation. In addition, late onset sepsis (LOS) empirical antibiotics are ampicillin gentamicin, ampicillin sulbactam, ceftazidime, cefosulbactam plus amikasin, and meropenem for selected cases. This study is aimed to evaluate novel empirical antibiotic guideline for neonatal sepsis. Material : We retrospectively evaluated newborn infants with suspected EOS and LOS from September 2017 until February 2018. Infants were classified into inborn and out born babies. Classification also further included primarily hospitalized for medical or surgical problems. Maternal infection risk and laboratory parameter of neonatal sepsis are used to classified mild and severe cases. Results : We recruited 776 newborn infants, 656 (84.5%) were inborn neonates while 120 (15.4%) were out born. The prevalence of EOS in inborn infants was 48.6% in medical and 61.5% in surgical. The prevalence of suspected EOS in out born group were 5.62% for medical and 22.72% for surgical. Blood culture positives EOS were only 1.7%. Coagulase negative Staphylococcus, Acinetobacter baumannii, and Candida parapsilosis were isolated from blood culture. Inborn LOS was suspected in 19.38% in medical and 15.38% in surgical. The prevalence of LOS for medical and surgical groups was 6.74% and 31.8%. Proven sepsis was found in 34.61% of suspected LOS cases. The most isolated microorganisms of LOS were Klebsiella pneumonia and Acinetobacter baumannii. Mortality was found in 1 out of 3 infants with proven EOS and LOS. Conclusions : Our current antibiotic guideline for neonatal sepsis could still be implemented with low rate of proven sepsis. The microorganism growth from blood culture can be considered as contaminant.