Antimicrobials utilization and outcomes of neonatal sepsis among patients admitted to a University Teaching Hospital in Malaysia

Neonatal sepsis is one of the most common reasons for admission to neonatal units in developing countries and it remains a significant cause of neonatal morbidity and mortality. Antimicrobial treatment of patients with sepsis is often predicated on the general principles of appropriate drug use and information extrapolated from other populations, rather than on evidence-based recommendations specific to these patients. Limited information is available about antibiotics use among neonates with suspected or confirmed sepsis in Malaysia and many regions of the world. This study aimed to explore and describe the clinical characteristics of neonatal sepsis; current pattern of antimicrobial use; the clinical outcomes of neonatal sepsis management; and to estimate the acquisition costs of the most commonly used antimicrobial regimens in the management of the condition. We retrospectively reviewed all cases of neonates admitted with sepsis to the Neonatal Intensive Care Unit (NICU) of Hospital Universiti Sains Malaysia; a university-based teaching hospital for one year. Both descriptive and inferential statistics were used for data analysis where appropriate. Of the 121 neonates included in the study, 89 (73.6%) presented with various risk factors for sepsis prior to or at the time of diagnosis and maternal risk factor was the highest reported (37.2%). About 26% of the neonates had positive culture and sensitivity tests. Of these, methicillin-resistant Staphylococcus aureus (MRSA) constituted the most prevalent microbial isolate (22.5%). All the patients received some form of empiric antibiotic therapy and crystalline penicillin G plus gentamicin regimen was the most commonly prescribed empiric therapy (69.4%). There was about 9-fold difference between the acquisition costs of the most widely and the second most widely used regimen (RM 29.32 per patient vs. RM 264.74 per patient). Four patients (3.3%) died during hospitalization in the NICU and 107 (88.4 %) were discharged clinically stable. Early treatment of neonatal sepsis with broad-spectrum antibiotics based on presenting signs and symptoms and clinical history had produced good clinical outcomes. This study has an important implication on guiding policy for developing comprehensive, evidence-based practice guidelines, adherence to which may lead to improved rational antibiotics use, costs reduction and improvement of overall care of patients with neonatal sepsis.