Point prevalence surveys of antimicrobial use among eight neonatal intensive care units in India: 2016

Sumanth Gandra,Gerardo Alvarez-Uria,Srinivas Murki,Sanjeev K Singh,Ravishankar Kanithi,Dasaratha R Jinka,Ashok K Chikkappa,Sreeram Subramanian,Anita Sharma,Dhanya Dharmapalan,Hemasree Kandraju,Anil Kumar Vasudevan,Onkaraiah Tunga,Akhila Akula,Yingfen Hsia,Mike Sharland,Ramanan Laxminarayan

doi:10.1016/j.ijid.2018.03.017

Abstract

BackgroundInformation about antimicrobial use is scarce and poorly understood among neonatal intensive care units (NICUs) in India. In this study, we describe antimicrobial use in eight NICUs using four point prevalence surveys (PPSs). MethodsAs part of the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children (GARPEC) study, one-day, cross-sectional, hospital-based PPSs were conducted four times between 1 February 2016 and 28 February 2017 in eight NICUs. Using a standardized web-based electronic data entry form, detailed data were collected for babies on antimicrobials. ResultsA total of 403 babies were admitted to NICUs across all survey days, and 208 (51.6%) were prescribed one or more antimicrobials. Among 208 babies, 155 (74.5%) were prescribed antimicrobials for treatment of an active infection. Among 155 babies with an active infection, treatment was empiric in 109 (70.3%). Sepsis (108, 49.1%) was the most common reason for prescribing antimicrobials. Amikacin (17%) followed by meropenem (12%) were the two most commonly prescribed antimicrobials. For community-acquired sepsis, piperacillin-tazobactam (17.5%) was the most commonly prescribed drug. A combination of ampicillin and gentamicin was prescribed in only two babies (5%). ConclusionsThe recommended first-line antimicrobial agents, ampicillin and gentamicin, were rarely prescribed in Indian NICUs for community acquired neonatal sepsis.

Highlights

An estimated 56,624 neonates die because of sepsis resulting from bacteria resistant to first-line antimicrobial agents (Laxminarayan and Bhutta, 2016)
We describe antimicrobial use in eight neonatal intensive care units (NICUs) in India using four point prevalence surveys (PPSs)
Four PPSs were conducted to improve the accuracy of antimicrobial use measurement and to examine the antimicrobial use variation at different time points

Summary

Introduction

An estimated 56,624 neonates die because of sepsis resulting from bacteria resistant to first-line antimicrobial agents (Laxminarayan and Bhutta, 2016). The median ampicillin resistance rate for common Gram-negative pathogens Klebsiella pneumoniae and Escherichia coli was 95.9% and 92.9%, respectively. Methods: As part of the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children (GARPEC) study, one-day, cross-sectional, hospital-based PPSs were conducted four times between 1 February 2016 and 28 February 2017 in eight NICUs. Using a standardized web-based electronic data entry form, detailed data were collected for babies on antimicrobials. Conclusions: The recommended first-line antimicrobial agents, ampicillin and gentamicin, were rarely prescribed in Indian NICUs for community acquired neonatal sepsis.

Methods

Results

Conclusion