Are Early-Onset Sepsis Evaluations and Empiric Antibiotics Mandatory for All Neonates Admitted with Respiratory Distress?

Objective  The objective of this study was to evaluate the success and safety of an antimicrobial stewardship protocol for neonates admitted with respiratory distress at birth. Study Design  A retrospective cohort analysis of all infants admitted to the neonatal intensive care unit (NICU) with respiratory distress from January 2013 to February 2018 was conducted. In April 2016, an antimicrobial stewardship protocol was implemented, dividing neonates into two groups: maternal indications for delivery (no infectious risk factors for early-onset sepsis [EOS]) and fetal indications (risk factors present) for delivery. Neonates with risk factors for EOS were started on empiric antibiotics, those who lacked risk factors were observed. Paired sample t -test and descriptive statistics were used to compare the pre- and postprotocol implementation. Results  There were no missed cases of EOS in our study. Management with empiric antibiotics decreased from 95 to 41% of neonates with respiratory distress after initiation of the protocol. Newborns with a lower mean (±standard errors of the mean [SEM]) gestational age were more likely to receive empiric antibiotics (35.1 ± 0.4 [range: 23–42 weeks] vs. 37.7 ± 0.2 weeks [range: 24–42 weeks]; p  < 0.05). Similar findings were seen for neonates with lower mean birth weights (2,627 ± 77 [range: 390–5,440 g] vs. 3,078 ± 51 g [range: 620–6,260 g]; p  < 0.05). Conclusion  The antibiotic stewardship protocol safely reduces the administration of empiric antibiotics to symptomatic neonates without missing any cases of sepsis. Key Points Newborns born with respiratory distress often receive broad-spectrum antibiotics upon NICU admission. An antibiotic stewardship program was created for this population and considered perinatal risk factors for sepsis when determining whether antibiotics were indicated. This antibiotic stewardship program was safe and effective, significantly reducing antibiotic use without missing any cases of sepsis. [ABSTRACT FROM AUTHOR]