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Australia-wide Point Prevalence Survey of Antimicrobial Prescribing in Neonatal Units: How Much and How Good?

Osowicki, Joshua MB BS*†; Gwee, Amanda MB BS*†; Noronha, Jesuina MB BS; Britton, Philip N. MB BS§; Isaacs, David MD§; Lai, Tony B. Pharm; Nourse, Clare MD‖**; Avent, Minyon Pharm D††‡‡; Moriarty, Paul MB BS; Francis, Joshua R. MB BS§§¶¶; Blyth, Christopher C. MB BS§§‖‖***†††; Cooper, Celia M. BM BS‡‡‡; Bryant, Penelope A. PhD*†‡§§§on behalf of the ANZPID-ASAP group (Australian and New Zealand Paediatric Infectious Diseases-Australasian Stewardship of Antimicrobials in Paediatrics)

The Pediatric Infectious Disease Journal: August 2015 - Volume 34 - Issue 8 - p e185–e190
doi: 10.1097/INF.0000000000000719
Antimicrobial Reports

Background: There is increasing recognition of the threat to neonatal patients from antibiotic resistance. There are limited data on antimicrobial prescribing practices for hospitalized neonates. We aimed to describe antimicrobial use in hospitalized Australian neonatal patients, and to determine its appropriateness.

Methods: Multicentre single-day hospital-wide point prevalence survey in 2012, in conjunction with the Antimicrobial Resistance and Prescribing in European Children study. The appropriateness of antimicrobial prescriptions was also assessed. All patients admitted at 8 am on the survey day, in 6 neonatal units in tertiary children’s hospitals across 5 states, were included in an analysis of the quantity and quality of all antimicrobial prescriptions.

Results: The point prevalence survey included 6 neonatal units and 236 patients. Of 109 patients (46%) receiving at least 1 antimicrobial, 66 (61%) were being treated for infection, with sepsis the most common indication. There were 216 antimicrobial prescriptions, 134 (62%) for treatment of infection and 82 (38%) for prophylaxis, mostly oral nystatin. Only 15 prescriptions were for targeted as opposed to empirical treatment. Penicillin and gentamicin were the most commonly prescribed antibiotics, with vancomycin third most common. Half of all treated patients were receiving combination antimicrobial therapy. There was marked variation in vancomycin and gentamicin dosing. Overall, few prescriptions (4%) were deemed inappropriate.

Conclusion: This is the first Australia-wide point prevalence survey of neonatal antimicrobial prescribing in tertiary children’s hospitals. The findings highlight positive practices and potential targets for quality improvement.

Supplemental Digital Content is available in the text.

From the *Infectious Diseases Unit, Department of General Medicine, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia; Murdoch Children’s Research Institute, Parkville, Victoria, Australia; Department of Paediatric Infectious Diseases, Monash Children’s Hospital, Clayton, Victoria, Australia; §Department of Infectious Diseases and Microbiology, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia; Pharmacy Department, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia; Infection Management and Prevention Service, Lady Cilento Children’s Hospital, South Brisbane, Queensland, Australia; **Department of Paediatrics, University of Queensland, South Brisbane, Queensland, Australia; ††Mater Pharmacy Services, Mater Health, South Brisbane, Queensland, Australia; ‡‡University of Queensland Centre for Clinical Research, South Brisbane, Queensland, Australia; §§Department of General Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia; ¶¶Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia; ‖‖School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia; ***PathWest Laboratory Medicine WA, Princess Margaret Hospital, Perth, Western Australia, Australia; †††Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; ‡‡‡SA Pathology, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia; and §§§Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.

Accepted for publication December 21, 2014.

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Penelope A. Bryant, PhD, Infectious Diseases Unit, Department of General Medicine, The Royal Children’s Hospital Melbourne, Parkville, VIC 3052, Australia. E-mail:penelope.bryant@rch.org.au.

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