Antimicrobial prescription and usage in the neonatal intensive care units of a Caribbean country: a prospective observational study.
OBJECTIVE
To study the prescribing patterns and usage of antimicrobials in the Neonatal Intensive Care Units (NICU) of Trinidad & Tobago.


METHODS
A 3-month prospective observational study was conducted at the three NICUs at the major public hospitals. Data included antimicrobials prescribed, route of administration, culture and sensitivity reports, leukocyte count, length of stay and outcome of patients.


RESULTS
353 patients were studied, 57.5% of the patients were males. Mean birth weight was 2.96 ± 0.94 (Standard Deviation) kg. Admission diagnoses included meconium stained liquor, preterm, respiratory distress, sepsis, etc. Length of stay ranged between 1 to 76 days, (median 4, Interquartile Range 1-8). The mean leukocyte count was 15.7 ± 8.5 × 103 per μL. Overall, 645 culture specimens were sent; umbilical swab (27.6%), throat swab (27.0%) and blood (16.4%) being the most common specimens. 310 (48.1%) showed no bacterial growth. Overall, 16 different antimicrobials were used. First line antibiotic of choice was a combination of ampicillin and gentamicin (85.8 %). Second line antibiotic of choice was cefotaxime. The overall mortality was 7.6%.


CONCLUSIONS
The choice of antimicrobials in the NICUs of major public hospitals is mostly empirical and not primarily dictated by the culture and sensitivity reports, emphasizing the need for antibiotic stewardship programme in Trinidad & Tobago.
Anesthesia and Intensive Care Unit, Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad & Tobago.
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Hariharan
Anesthesia and Intensive Care Unit, Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad & Tobago.
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Chen
Anesthesia and Intensive Care Unit, Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad & Tobago.
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Harry
Anesthesia and Intensive Care Unit, Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad & Tobago.
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Ragobar
Anesthesia and Intensive Care Unit, Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad & Tobago.
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Boodoosingh
Anesthesia and Intensive Care Unit, Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad & Tobago.
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C
Gangoo
Anesthesia and Intensive Care Unit, Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad & Tobago.
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Hector
Anesthesia and Intensive Care Unit, Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad & Tobago.
J
J
Reid
Anesthesia and Intensive Care Unit, Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad & Tobago.
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Raju
D000890:Anti-Infective Agents / Q000008:administration & dosage*; D001419:Bacteria / Q000302:isolation & purification; D001724:Birth Weight; D056890:Eukaryota / Q000302:isolation & purification; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000188:drug therapy*; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D007902:Length of Stay; D007958:Leukocyte Count; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D016896:Treatment Outcome; D014300:Trinidad and Tobago
D000890:Anti-Infective Agents
Antimicrobials; neonatal intensive care; prescription patterns; usage