Effect of Antimicrobial Stewardship Interventions on Clinical Outcomes and Antimicrobial Resistance among Neonates with Sepsis in Selected Health Facilities in Kiambu County, Kenya

Background: Neonatal sepsis remains an important cause of neonatal morbidity and mortality, while inappropriate and prolonged antimicrobial use contributes to antimicrobial resistance and adverse drug events. Antimicrobial stewardship (AMS) interventions provide a strategy for optimizing antimicrobial selection, dosing, duration, and review while maintaining effective treatment of infection.
Methods: A quasi-experimental interrupted time-series design with a non-equivalent comparison group was used. The study involved neonates aged 0–28 days diagnosed with neonatal sepsis in selected Level 4 and Level 5 hospitals in Kiambu County. Intervention facilities implemented antimicrobial stewardship interventions comprising prescribing guidelines, audit and feedback, diagnostic stewardship, antimicrobial review, de-escalation, and healthcare-provider training, while comparison facilities continued routine care. Quantitative data were obtained through medical record review and healthcare-provider questionnaires, while qualitative information was collected through key informant interviews. Data were analyzed using SPSS version 30.0. Descriptive statistics, chi-square/Fisher's exact tests, Mann–Whitney U tests, segmented regression, and multivariable regression were used.
Results: Recovery was higher among neonates in the intervention group than the control group, 100 (93.5%) versus 82 (76.6%), while mortality was lower, 2 (1.9%) versus 9 (8.4%). Adverse drug reactions occurred in 3.7% of intervention neonates compared with 15.9% of controls, while 28-day readmission was 3.7% versus 13.1%, respectively. Hospitalization was shorter among intervention neonates, with 32.7% discharged within seven days compared with 3.7% of controls, while stays exceeding 14 days occurred in 11.2% and 42.1%, respectively. Stewardship processes also improved substantially. Guideline-concordant prescribing increased to 86.0%, blood cultures before therapy to 93.5%, appropriate dosing to 99.1%, therapy review at 48–72 hours to 81.3%, culture-guided therapy to 85.0%, and de-escalation to 84.1%. MDR organisms occurred in 16.8% of intervention cases compared with 40.2% of controls, while ESBL-producing organisms occurred in 7.5% versus 19.6%, respectively.
Conclusions: Antimicrobial stewardship interventions were associated with improved antimicrobial prescribing practices, reduced antimicrobial resistance indicators, and better neonatal clinical outcomes. Structured stewardship programs should therefore be strengthened and institutionalized within neonatal units in Kenya.

Antimicrobial stewardship, neonatal sepsis, antimicrobial resistance, neonatal outcomes

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