Neonatal infantSurveillance of all antibiotic use in a level 3 neonatal ICU indicated the majority of antibiotic prescriptions were narrow-spectrum and would not be monitored by most stewardship programs.

Ninety-four percent of antibiotic use was initiated as empiric therapy for suspected infections, at a rate of 323 days of therapy per 1,000 patient-days. Five percent of antibiotic therapy administered for suspected infections eventually were confirmed by positive cultures.

Prolonged (5 days or more) antibiotic therapy despite sterile cultures accounted for 26% of antibiotic use. Pneumonia (16%) and culture-negative sepsis (8%) were the most frequent reasons for prolonged therapy. Sixty-four percent of pneumonia and 69% of culture-negative sepsis cases were treated for at least 7 days.