In 2012, an extensive antibiotic policy program created by the members of the hospital’s infection control team (ICT) was implemented. The ICT members included a physician (an epidemiology and pediatrics specialist), a clinical pharmacist, a clinical microbiologist, and an epidemiological nurse. Before introduction of the antibiotic policy, the hospital informed the Drugs and Therapeutics Committee (DTC) and a written antibiotic formulary defined as a list of antibiotics used in a hospital was established. The HAP was defined as written guidelines for prescribing antibiotics. The antibiotics used in the hospital were divided into three groups: first line (1st line) antibiotics (e.g., penicillins, 1st generation cephalosporins), second line (2nd line) antibiotics (e.g., macrolides, 2nd and 3rd generation cephalosporins, amoxicillin with clavulanic acid, piperacillin with tazobactam), and third line (3rd line), restricted antibiotics only available after pre-authorization (or additional authorization) by a physician from the infection control team (e.g., glicopeptides, carbapenems).

Data on the quantitative and qualitative use of antibiotics in 2011 and 2012 were reported by the hospital’s pharmacy. The data represented the dispensing of antibiotics from the hospital pharmacy to the Special Neonatal Care Unit. The annual report on the total volume of antibiotics prescribed was analyzed. The antibiotic use was calculated in daily defined doses (DDDs) per 100 patient-days and DDDs per 100 admissions according to the Anatomical Therapeutic Chemical Classification (ATC) System, from the WHO, version 2009. Furthermore, antibiotics were ranked by volume of DDDs and the number of antibiotics, which accounted for 90 % and 100 % of the total volume (DU90% and DU100%, respectively, where DU stands for drug use). The non-parametric variables were analyzed using the χ² test with a p-value of <0.05 considered as statistically significant. The data were analyzed using an SPSS commercial package (SPSS Inc., Chicago, IL).