Antibioterapia într-o unitate neonatală terţiară – utilizare justificată sau abuz?

Introduction. As the multiresistant bacteria emerge, the use of antibiotic treatment requires a clear justification, so that the benefit-risk ratio is both in favor of the individual patient and society. Materials and method. This paper represents a retrospective study that evaluated the use of antibiotics in a group of 241 newborns in the “Bucur” Maternity, Bucharest, Romania, during 2018-2020. We analyzed, using the SPSS Statistics 20 program, variables such as gestational age, birth weight, mode of delivery, Apgar score, C-reactive protein, diagnoses, antibiotics used, duration of antibiotic treatment, as well as multiple correlations between them. Results. The rate of term new­borns was 52% (n=107), while premature babies re­pre­sented 48% (n=100). Mean C-reactive protein was 1.117 mg/dl (first day), 0.712 mg/dl (third day) and 1.2 mg/dl (fifth day). The most frequently used antibiotics were ampicillin (n=197; 39.1%) and gentamicin (n=168; 33.3%). The longest average duration of antibiotic treatment was recorded by gentamicin (5.21 days; SD: 9.159) and ampicillin (4.92 days; SD: 8.02). The infectious pathology was present in 62 cases and included: suspected maternal-fetal infection (n=20; 6.7%), maternal-fetal infection (n=19; 6.4%), perinatal infection (n=18; 6%) and neonatal sepsis (n=5; 1.7%). The use of ampicillin or gentamicin was more frequently associated with the absence of an infectious pathology, and this fact is statistically significant. Thus, 69.49% (164 cases) of those without infections and only 12.29% (29 cases) of those with infections received ampicillin (X2=11.21; p value 2-sided=0.001). Regarding gentamicin, 54.24% (128 cases) received the antibiotic although they did not have an infectious pathology, and 15.68% (37 cases) had infectious pathology and received treatment (X2=4; p value 2-sided=0.045). Conclusions. The justification of antibiotic treatment in newborns was not always present and it was observed a tendency to overmedication in this age category with possible risks, such as adverse reactions and the selection of resistant germs, that do not always outweigh the benefits. More regulations regarding the indications of antibiotic treatment in new­borns are needed in order to avoid possible risks, both at the individual and the community level.