A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study

Abstract

Background Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. Methods We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. Findings On July 1, 2019, 26% of infants (580/2,265; range, 0–100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received ≥1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were “rule-out” sepsis (32%) and “culture-negative” sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and “culture-negative” infections was 12 days (median; IQR, 8–14) and 7 days (median; IQR, 5–10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization ( p = 0·02). Interpretation Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide. Funding Merck & Co.; The Ohio State University College of Medicine Barnes Medical Student Research Scholarship

Evaluation of antibiotic prescriptions for sepsis in the Neonatal Intensive Care Unit in a Tertiary Hospital in North Sumatera, Indonesia

“…Gentamycin was the most common antibiotic prescribed in our NICU (72.22%), followed by cefotaxime (71.60%). This finding was similar to the results of studies conducted by Prusakov et al [2]. A combination of meropenem and amikacin was the recommended antibiotic therapy in a study by Weldu et al, while in our study the most commonly selected combination antibiotic in the NICU was cefotaxime and gentamycin [18].…”

“…Sepsis was confirmed in only 16.36% of all cultures included in our study. this rate was higher than the one found by Tank et al, who reported only 4% culture positivity, but it was similar to that reported by Prusakov et al, citing 20% confirmed sepsis cases in their study [2,14]. Low culture positivity is a common problem in pediatric patients, particularly in neonates.…”

“…neonatal sepsis is one of the major causes of infant mortality, accounting for 13% of neonatal deaths worldwide, especially in developing countries [1]. Antibiotics are the most commonly used medications in newborn wards and neonatal intensive care units (NICUs) [2]. Neonatal sepsis has nonspecific manifestations and results in serious complications.…”

“…Neonatal sepsis has nonspecific manifestations and results in serious complications. Therefore, clinicians often administer antibiotics to infants at high risk of sepsis during hospitalization, despite only 5% of culture results returning positive [2,3]. Approximately 60% of antibiotics are administered for more than 72 hours even in the presence of a negative blood culture, and a prolonged use of antibiotics is known to increase the risk of late-onset sepsis, necrotizing enterocolitis, and even death [3,4].…”

International train the trainer neonatal antibiotic stewardship program for South African pharmacists

“…The US component of the bilateral TTT NICU‐ASP provides 2‐weeks of training in a Level IV NICU with an established multidisciplinary NICU‐ASP at NCH 11,12 . Our goal was to teach South African pharmacists the role of a NICU pharmacist to promote the judicious use of antimicrobials and enhance the quality of care of neonates.…”