Use of antibiotics in suspected early-onset neonatal sepsis

Introduction: Early-onset neonatal sepsis is a rare, but life-threatening condition. In 2017, the Hungarian Neonatal Society issued a national guideline to rationalize the use of antibiotic use in neonatal sepsis. Objective: To retrospectively determine the frequency of prescribed antibiotics before and after the introduction of national guidance. Method: Data of neonates (>34. gestational weeks) delivered in our hospital between 1st January 2014 and 31st December 2018 were analysed with focusing on signs of sepsis, number of neonates treated with antibiotics, incidence of early-onset neonatal sepsis, sepsis-related mortality. Statistical analysis was performed with RStudio software (significance: p<0.05). Results: During the analysed time period, 12 347 neonates were born, 1502 (12.16%) neonates were given antibiotics, showing a significant decrease after 2017: 517 (21.10%) in 2014, 401 (16.63%) in 2015, 459 (17.96%) in 2016, 61 (2.39%) in 2017, 64 (2.69%) in 2018, respectively. Out of the group of neonates treated with antibiotics (n = 1502), only 239 (15.91%) neonates showed the clinical signs of sepsis. No significant change was observed in the number of symptomatic newborns during the study period: 52 (2.12%) in 2014, 42 (1.74%) in 2015, 42 (1.64%) in 2016, 46 (1.80%) in 2017, 57 (2.40%) in 2018, p = 0.285. Blood culture confirmed neonatal sepsis was observed in 4 babies, incidence of early-onset neonatal sepsis was 0.324/1000, sepsis-related mortality was zero. Discussion: Before the introduction of the national guideline, most of the neonates were prescribed antibiotics based on risk factors. Since 2017, antibiotics have been mainly preserved for newborns with clinical signs of sepsis. Despite cessation of antiobiotic treatment indicated by risk factors, the number of symptomatic babies and sepsis-related mortality have not increased. Conclusion: The use of antibiotics for neonates >34th gestational week can be safely reduced, entailing a decrease in short-and long-term complications of early antibiotic use.