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Purpose: The prevalence of antibiotics resistant bacterial infection among preterm infants has been increased due to indeliberate use of prophylactic broad spectrum antibiotics. The objective of this study was to assess the effectiveness of restricted usage of prophylactic antibiotics by comparing the incidence of culture proven early onset sepsis (EOS). Methods: This was a retrospective cohort study for extremely low birth weight infants who were born in Seoul National University Children's Hospital during 2009-2014. The groups were divided into two periods, from 2009 to 2011 (period I) and from 2012 to 2014 (period II) based on the implementation on quality improvement activity since 2012. The indication of prophylactic antibiotics were; 1) umbilical vein catheter (UVC) insertion for resuscitation in delivery room, 2) prolonged preterm premature rupture of membrane >18 hours, 3) maternal fever during labor or sustained septic amniotic fluid. The incidence of EOS and the rate of empirical antibiotics usage were compared between two periods. Results: A total of 245 infants were admitted to the neonatal intensive care unit during the study period. Baseline demographics and clinical characteristics were similar between two periods except UVC insertion rate. The rate of empirical antibiotics usage significantly decreased in period II (71.1% for period I vs. 56.4% for period 2, P=0.022). Incidence of EOS was not different between two periods whether prophylactic antibiotics use or not. Conclusion: Quality improvement for reducing prophylactic antibiotics use may be effective to reduce a use of antibiotics without increasing EOS. [ABSTRACT FROM AUTHOR]

This study was conducted to provide the base line for the use of prophylactic antibiotics and the standard of antibiotic use and the evaluation based on analysis of current use, quality assessment and periodic changes of prophylactic antibiotics in a university hospital. We chose the year 2008, 2009, 2010, 2012, and 2014 as the study periods since the primary evaluation on the first year of implementation in 2007. For this study, healthcare benefit quality assessment data from the Health Insurance Review and Assessment Service was used. We analyzed the differences each year of treatment period; one category for initial treatment timing, three categories for selecting antibiotics, and two categories for the length of treatment from multiple evaluation indices of gastric surgeries, colorectal surgeries, and cholecystectomy. The analysis revealed the followings: Regarding length of antibiotics treatment, total days of treatment decreased down to 1.5, 1.5, and 0.6 days in the year 2014, from 13.5, 12.8, and 6.9 days in the year 2007, for gastric surgeries, colorectal surgeries, and cholecystectomy. Based on these outcomes, the efforts to devise efficient delivery and distribution of the recommendations or indices which medical staff could adhere for quality improvement of the prophylactic antibiotics would be necessary. Also implementing monitoring system to help the hospitals to acknowledge their own faults may be helpful. [ABSTRACT FROM AUTHOR]