Ophthalmic Antibiotic Prophylaxis as a Target for Antibiotic Stewardship: A Point Prevalence Multicentre Survey on Practices, Guideline Adherence, and Incidence of Ophthalmia Neonatorum within the ESPR Network

INTRODUCTION: Ophthalmia Neonatorum (ON) is a serious neonatal eye infection, primarily caused by Chlamydia trachomatis (CT) or Neisseria gonorrhoeae (NG). Although the World Health Organization (WHO) recommends universal antibiotic prophylaxis at birth, many high-resource countries have suspended this procedure. European data on incidence of ON and prophylaxis use are limited. AIMS: To evaluate the routine implementation of prophylaxis across a selected sample of European birth centres, to assess adherence to WHO recommendations, and estimate the incidence of conjunctivitis caused by CT and NG among newborns, comparing centres with and without prophylaxis. METHODS: An electronic questionnaire was distributed to 94 birth centres in 21 European countries, focusing on those with significant birth volumes and university or referral hospital status. Data collection occurred over two days, 20-21 November 2024, with cases of CT/NG conjunctivitis reported for 2023. RESULTS: Among 94 responding centres, 54 (57.5%) routinely implemented prophylaxis, but 74% of them did not adhere to WHO guidelines. Of 1,636 newborns observed, 598 (36.6%) received prophylaxis at birth. Seventeen cases of CT/NG conjunctivitis were reported in 2023, with similar incidence rates in centres with and without prophylaxis (6.2 vs. 5.8 per 100,000 live births; p = 0.89). CONCLUSIONS: Variations in ocular prophylaxis across involved centres, coupled with low rates of NG and CT conjunctivitis and no significant differences between centres using or not using prophylaxis, suggest that this practice could inform antibiotic stewardship in newborns. A unified, evidence-based European protocol is essential to enhance safety and reduce early antibiotic use.