Preliminary Investigation Of Evaluation Of Antiobotics Inappropriate USE For Neonatal Late Onset Sepsis In Three Hospitals Including Chinese And French

Objective:Evaluation and comparison of antibiotics inappropriate use for late onset neonatal sepsis in Chinese and French hospitals.Methods:Retrospective observational study of antibiotic use was performed in neonatal service of Children’s Hospital of Toulouse III University (CHTU), Hospital of Haute Pierre of Strasbourg University (HHPSU) and Children’s Hospital of Chongqing Medical University (CHCMU) to assess adherence to the guidelines defined by the CDC 12-Step Campaign using predetermined criteria. Infants who received antibiotics at greater than 72 hours of age were involved. Antibiotic regimens, clinical and microbiologic data, and indications for initiation and continuation of antibiotics (after 72 hours of use) were recorded. Inappropriate utilization was characterized at initiation, continuation, by agent, and by CDC 12-Step.Results:The median antibiotics courses from CHTU was 7 days (range, 4-10days), the median antibiotics courses from HHPSU was 9.5 days (range,5-13days), the median antibiotics courses from CHCMU was 14 days (range,7-18 days). Twenty (44%) courses of CHTU, twenty-seven (59%) courses of HHPSU and twenty (72%) courses of CHCMU were judged to be non-adherent to a CDC 12-Step. Inappropriate use was more common with continuation of antibiotics than with initiation of therapy (CHTU 47% vs.13%, HHPSU 67% vs.4%, CHCMU 71% vs.27%, P<0.05). Vancomycin was the most commonly used drug (n=284 antibiotic-days) of which 47 (22%) days were considered inappropriate in CHTU; vancomycin was the most commonly used drug (n=386 antibiotic-days) of which 71 days (18%) were considered inappropriate in HHPSU; imipenem was the most commonly used drug (n= 197 antibiotic-days) of which 59 days (36%) were considered inappropriate in CHCMU. Common reasons for non-adherence at the time of continuation were failure to stop treatment if infection was cured or unlikely. Compared with 2 French hospitals, CHCMU used much more broad-spectrum antibiotics inappropriate(CHTU10%, HHPSU5%, CHCMU43%, P<0.05).Conclusions:Antibiotics use for late onset neonatal sepsis both in Chinese and French hospitals were not optimistic, CHCMU was the worst. Improvement efforts should target antibiotics use 72 hours after initiation, particularly paying more attentions to infants’ clinical signs and results of infection biomarker, stopping treatment immediately when infection was cured or unlikely. Meanwhile, CHCMU’s neonatologists should avoid carbapenems abuse.