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Dr. Damera Yadaiah

Nodal Ofiicer, SNCU, Nalgonda

Title: Rationalizing antibiotic use in Special Newborn Care Unit, in a low resource setting

Biography

Biography: Dr. Damera Yadaiah

Abstract

Misuse of antibiotics is one the most common reason for drug resistant HAI and increased mortality in intensive care units, more so in the neonatal units. There is an urgent need to optimize the use of antibiotics across all neonatal settings. In this study we evaluate the effects of introduction and implementations of an antibiotic prescription form in our unit from September 2018.

Study objective: To evaluate the effect on implementation of antibiotic prescription form in reducing neonatal mortality and hospital duration.

Study design: Before and after observational study

Study Duration: September 2017 to August 2019

Methods:All patients admitted to the special care neonatal unit at Nalgonda district hospital from September 2017 to August 2019were eligible for this study. Data collected included

  • Birth weight
  • Gestation
  • Sex
  • Place of delivery
  • Asphyxia
  • Meconium aspiration syndrome
  • Discharge, death, LAMA or referral
  • Details of antibiotics

In September 2018, a policy was introduced to improve antibiotic usage and hence a antibiotic prescription form was implemented. Serial one to one training of doctors, nursing staff was done to implement the prescription form and use antibiotics only when needed. CME and workshops were conducted on the role and methods of antibiotic stewardship from September to December 2018. Compliance to use of prescription form was strictly adhered to from January 2019.

Outcomes

  • Change in mortality, mortality among VLBW infants and mortality due to sepsis
  • Duration of hospital stay
  • Relation with antibiotic usage and reduction in mortality
  • Reduction in costs due to reduced antibiotic usage and cost saved per patient

Results

During the study a total of 2171 infants were admitted to the SNCU. The figures show the neonatal admissions and relation of antibiotic usage to neonatal mortality. There was a significant reduction in the number and proportion deaths in infants with

  • Gestation <34 weeks (45/248, 18.1% Vs. 17/186, 9.14%, p =0.008).
  • Birth weight <1500 grams (34/68, 50% Vs. 11/29, 37.9%, p =0.275).
  • Death rate in infants with sepsis also reduced with the introduction of antibiotic policy (19/68, 27.9% Vs. 5/29, 17.2%, p =0.263).
  • The proportion of infants staying for >24 hours reduced significantly with the introduction of antibiotic policy.
  • Significant reduction in the cost to the unit and cost per patient.

Conclusion

Introduction of justification form reduced

Antibiotics usage – 16.6%

Antibiotics usage per patients days – 25.2%

Cost of Antibiotics to the unit – 13.2%   

Average hospital stay – 2.6 days.

One in six patients then, one in 50th patients now on antibiotics

Cost saved per patients per day Rs 365/- (INR)

Cost of one paper of justification form is negligible, Rs 0.40 paisa (INR)

A simple use of antibiotic prescription form and strict adherence to is likely to reduce antibiotic usage and result in reduction in neonatal mortality and hospital duration.