Comparative Evaluation of Antimicrobial Use in Neonates at Risk for Early-onset Neonatal Sepsis Using Different Diagnostic Strategies in a Neonatal Care Unit.

BACKGROUND: Early-onset disease (EOD) remains one of the most common causes for initiating antibiotics. In response, diagnostic approaches such as the guidelines by the National Institute for Health and Care Excellence (NICE) and the American Academy of Pediatrics (AAP) have been proposed. The Kaiser-Permanente model by the AAP estimates the probability of EOD per 1000 births in neonates born at ≥34 weeks' gestation. This study aims to evaluate the antibiotic use in a neonatal department for suspected EOD cases and to compare the existing practice-a combination of NICE guidelines and individual physician judgement-with the official guidelines of NICE and AAP for initiating treatment.

METHODS: A retrospective study was conducted at the Neonatology Department of the National and Kapodistrian University of Athens, Aretaieio Hospital, from January 2018 to December 2021.

RESULTS: Among the participants (N = 259), 21.2% received antibiotics, but only 13.5% in full accordance with NICE guidelines. The remaining cases were treated based on physician discretion, outside NICE or AAP criteria. The Kaiser model resulted in the lowest antimicrobial use (10.9%), compared with the risk-based (58.2%) and the serial physical examination (SPE) strategies (60%) for the treated neonates. Only the SPE method accurately identified the single confirmed case of EOD. The combination of Kaiser and SPE models was associated with low antimicrobial use (13%) and early detection of true GBS-EOD.

CONCLUSION: Antimicrobial use in neonates should adhere only to established guidelines, by NICE or AAP. However, combining Kaiser and SPE strategies may minimize the antimicrobial overuse and ensure timely treatment for confirmed EOD.