Antibiotherapy in a tertiary neonatal care unit – use or abuse?
F.E. Augustin, I.M. Conea, M. Amza, R.M. Sima, L. Pleş
Rezumat: Introduction. As the multiresistant bacteria emerge, the use
of antibiotic treatment requires a clear justification, so that
the benefit-risk ratio is both in favor of the individual patient
and society. Materials and method. This paper represents a
retrospective study that evaluated the use of antibiotics in a
group of 241 newborns in the “Bucur” Maternity, Bucharest,
Romania, during 2018-2020. We analyzed, using the SPSS
Statistics 20 program, variables such as gestational age, birth
weight, mode of delivery, Apgar score, C-reactive protein,
diagnoses, antibiotics used, duration of antibiotic treatment,
as well as multiple correlations between them. Results. The
rate of term newborns
was 52% (n=107), while premature
babies represented
48% (n=100). Mean C-reactive protein
was 1.117 mg/dl (first day), 0.712 mg/dl (third day) and
1.2 mg/dl (fifth day). The most frequently used antibiotics
were ampicillin (n=197; 39.1%) and gentamicin (n=168;
33.3%). The longest average duration of antibiotic treatment
was recorded by gentamicin (5.21 days; SD: 9.159) and
ampicillin (4.92 days; SD: 8.02). The infectious pathology
was present in 62 cases and included: suspected maternalfetal
infection (n=20; 6.7%), maternal-fetal infection (n=19;
6.4%), perinatal infection (n=18; 6%) and neonatal sepsis
(n=5; 1.7%). The use of ampicillin or gentamicin was more
frequently associated with the absence of an infectious
pathology, and this fact is statistically significant. Thus,
69.49% (164 cases) of those without infections and only
12.29% (29 cases) of those with infections received ampicillin
(X2=11.21; p value 2-sided=0.001). Regarding gentamicin,
54.24% (128 cases) received the antibiotic although they did
not have an infectious pathology, and 15.68% (37 cases) had
infectious pathology and received treatment (X2=4; p value
2-sided=0.045). Conclusions. The justification of antibiotic
treatment in newborns was not always present and it was
observed a tendency to overmedication in this age category
with possible risks, such as adverse reactions and the selection
of resistant germs, that do not always outweigh the benefits.
More regulations regarding the indications of antibiotic
treatment in newborns are needed in order to avoid possible
risks, both at the individual and the community level. Cuvinte cheie: antibiotics, neonatology, infections, C-reactive protein.