McAleese Samuel, Parikh Tushar B, Ouddi Basma, Schumacher Christina M, Johnson Julia
Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.
BMJ Paediatr Open. 2025 Jan 7;9(1):e003095. doi: 10.1136/bmjpo-2024-003095.
Antibiotic use for early-onset neonatal sepsis (EONS) is common, but prolonged exposure can lead to poor outcomes. Laboratory capacity and infection prevention initiatives may impact antibiotic use for EONS in neonatal intensive care units. The objective of this study was to examine the influence of institutional capacity on antibiotic prescribing for EONS in India.
Between September 2023 and January 2024, we surveyed Indian paediatricians and neonatologists regarding institutional capacity and antibiotic prescribing practices for EONS. Five vignettes with varying maternal and infant risk profiles explored participants' decision to initiate empiric antibiotics at birth and the timing of discontinuation of antibiotics in term and preterm infants at risk for EONS. Variation in reported initiation and discontinuation of empiric antibiotic use by institutional capacity and antimicrobial stewardship initiatives were assessed using logistic regression models.
Of 317 respondents, most (91%) reported antimicrobial stewardship initiatives at their institution and 56% reported receiving blood culture results within 48 hours. Screening tests such as complete blood count and C reactive protein were used in 56%-67% of cases, and abnormal results led to longer courses with fewer than 10% of respondents discontinuing antibiotics by 72 hours. When controlling for infant and maternal characteristics, the adjusted OR of observing infants without empiric antibiotics at birth was 0.38 (95% CI 0.16 to 0.70) for participants without infection prevention initiatives and was 1.57 (95% CI 1.05 to 2.35) for participants with timely (<48 hours) reporting of blood culture results, respectively. Infection prevention initiatives and laboratory capacity were not associated with increased odds of early discontinuation of empiric antibiotics for EONS.
Infection prevention and laboratory capacity may decrease the initiation of empiric antibiotics but are not associated with early discontinuation of empiric antibiotics for EONS. The use of sepsis screening tests remains common in Indian neonates and requires additional study.
早期新生儿败血症（EONS）使用抗生素很常见，但长时间使用可能导致不良后果。实验室能力和感染预防措施可能会影响新生儿重症监护病房中EONS的抗生素使用情况。本研究的目的是探讨机构能力对印度EONS抗生素处方的影响。
在2023年9月至2024年1月期间，我们就机构能力和EONS的抗生素处方实践对印度儿科医生和新生儿科医生进行了调查。五个具有不同母婴风险特征的病例描述探讨了参与者在出生时启动经验性抗生素治疗的决定，以及有EONS风险的足月儿和早产儿停用抗生素的时机。使用逻辑回归模型评估机构能力和抗菌药物管理措施导致的经验性抗生素使用起始和停用报告的差异。
在317名受访者中，大多数（91%）报告其所在机构有抗菌药物管理措施，56%报告在48小时内获得血培养结果。56%-67%的病例使用了全血细胞计数和C反应蛋白等筛查试验，异常结果导致疗程延长，不到10%的受访者在72小时内停用抗生素。在控制婴儿和母亲特征后，对于没有感染预防措施的参与者，出生时未使用经验性抗生素观察婴儿的调整后比值比为0.38（95%CI 0.16至0.70），对于血培养结果及时（<48小时）报告的参与者，该比值比为1.57（95%CI 1.05至2.35）。感染预防措施和实验室能力与EONS经验性抗生素早期停用几率增加无关。
感染预防和实验室能力可能会减少经验性抗生素的起始使用，但与EONS经验性抗生素的早期停用无关。败血症筛查试验在印度新生儿中仍很常见，需要进一步研究。
