Antimicrobial Stewardship Program in a Low-Middle Income Country: Impact of an Antibiotic Guideline for Neonatal Early-Onset Sepsis.
Antibiotic stewardship guideline linked to much higher adherence to best practices in neonatal sepsis
Antimicrobial Stewardship Program in a Low-Middle Income Country: Impact of an Antibiotic Guideline for Neonatal Early-Onset Sepsis.
Initiation of empiric antibiotic therapy for neonatal early-onset sepsis (early-onset sepsis) is prudent to prevent morbidity and mortality, particularly in low- and middle-income countries (low- and middle-income countries).
In this study, we aimed to evaluate adherence to a locally developed and adopted guideline for antibiotic use in early-onset sepsis.
We conducted a retrospective before-and-after study during the pre- (June 2024-January 2025) and post-implementation (May-December 2025) of antimicrobial stewardship programs guideline for early-onset sepsis.
post-guideline stewardship practices were followed roughly two-thirds of the time
In a cohort of 388 neonates with early-onset sepsis (i.e., 205 pre- and 183 post-implementation), the median gestational age was 38 (IQR: [37-39]) weeks, with the median birthweight of 3000 (IQR: [2800-3400]) grams, and 63% were male.
In the post period, adherence rates were 96.7% for empiric antibiotics indication, 95.6% for antibiotics indication after culture results are obtained, 88.5% for antibiotic dosing, 83.1% for timely antibiotic initiation, and 89.1% for appropriate discontinuation of antibiotics.
The results support the effectiveness of antimicrobial stewardship programs implementation in improving guideline adherence and reducing antibiotic exposure among neonates with early-onset sepsis in low-resource settings.
In-hospital clinical outcomes, including mortality at discharge, were similar between periods; however, further studies with longer follow-up are needed to better evaluate clinical outcomes.