Audit of antibiotic prescribing patterns before and after ICMR STW implementation in neonatal sepsis

Abstract

Background: Antibiotic overuse in neonatal intensive care units (NICUs) contributes significantly to antimicrobial resistance (AMR) and adverse clinical outcomes. In response, the Indian Council of Medical Research (ICMR) introduced Standard Treatment Workflows (STWs) in 2022 to promote rational antibiotic use in neonatal sepsis.

Objective: This audit aimed to compare antibiotic prescribing patterns before and after the implementation of the ICMR STW in a level III NICU. Methods: We conducted a retrospective audit of NICU admissions over two six-month periods in 2024. The pre-implementation phase spanned from January to June, while the post-implementation phase covered July to December. The ICMR STW was operationalized using a structured proforma that guided documentation of clinical signs, indications for initiating antibiotics, culture testing, and escalation decisions. NICU nurses were actively involved in ensuring compliance through real-time monitoring.

Results: Among 216 neonates admitted during the study period, 109 were admitted before and 97 after STW implementation. The proportion of neonates receiving antibiotics declined from 31% in the pre-implementation phase to 18% post-implementation (p =0.023). Culture-positive sepsis was observed only in the pre-intervention phase and was rare overall (1.4%). The use of higher antibiotics also decreased, from 41% to 29% (p=0.43), while the mean duration of antibiotic therapy remained consistent at 5 days.

Conclusion: The introduction of the ICMR STW improved antibiotic stewardship in our NICU by reducing both the number of prescriptions and the use of higher antibiotics. This success was achieved through structured documentation and active nursing engagement and may serve as a scalable model for other NICUs.