A simple and feasible antimicrobial stewardship program in a neonatal intensive care unit of a Japanese community hospital

Kitano, Taito; Takagi, Kumiko; Arai, Ikuyo; Yasuhara, Hajime; Ebisu, Reiko; Ohgitani, Ayako; Kitagawa, Daisuke; Oka, Miyako; Masuo, Kazue; Minowa, Hideki

doi:10.1016/j.jiac.2019.04.012

Cited by 14 publications

(40 citation statements)

References 28 publications

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“…Bhat et al [25] achieved reduction of all antibiotic utilization rates from 154.8 to 138.4 DOT. Kitano et al [27] achieved a decrease from 175.1 to 41.6 DOT. Only one study (Nzegwu et al [31]) did not find a significant decrease of total antibiotic consumption.…”

Section: Resultsmentioning

confidence: 99%

“… Percentage of infants receiving prolonged (>48 h) antibiotic therapy. Kitano et al [27] achieved a reduction of prolonged antimicrobial treatments from 65 to 32.5%. Lu et al [28] had an increase in percentage of discontinued antibiotic courses ≤48 h from 32 to 95%.…”

Section: Resultsmentioning

confidence: 99%

“…Bhat et al [25] encouraged empirical antibiotic use only in the presence of perinatal risk factors for EOS or in infants with postnatal clinical illness suggestive of evolving sepsis. Kitano et al [27] implemented comprehensive criteria for initiation of antibiotic treatment, based on maternal chorioamnionitis, infant’s clinical presentation, and laboratory values combined. Both Kitano et al and Bhat et al [25, 27] also applied interventions from the 2 other areas of action.…”

Section: Resultsmentioning

confidence: 99%

“…Kitano et al [27] implemented comprehensive criteria for initiation of antibiotic treatment, based on maternal chorioamnionitis, infant’s clinical presentation, and laboratory values combined. Both Kitano et al and Bhat et al [25, 27] also applied interventions from the 2 other areas of action.…”

Section: Resultsmentioning

confidence: 99%

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Antibiotic Stewardship in Premature Infants: A Systematic Review

et al. 2020

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Introduction: Antibiotic treatment in premature infants is often empirically prescribed, and practice varies widely among otherwise comparable neonatal intensive care units. Unnecessary and prolonged antibiotic treatment is documented in numerous studies. Recent research shows serious side effects and suggests long-term adverse health effects in prematurely born infants exposed to antibiotics in early life. One preventive measure to reduce unnecessary antibiotic exposure is implementation of antibiotic stewardship programs. Our objective was to review the literature on implemented antibiotic stewardship programs including premature infants with gestational age ≤34 weeks. Methods: Six academic databases (PubMed [Medline], McMaster PLUS, Cochrane Database of Systematic Reviews, UpToDate, Cochrane Central Register of Controlled Trials, and National Institute for Health and Care Excellence) were systematically searched. PRISMA guidelines were applied. Results: The search retrieved 1,212 titles of which 12 fitted inclusion criteria (11 observational studies and 1 randomized clinical trial). Included articles were critically appraised. We grouped the articles according to common area of implemented stewardship actions: (1) focus on reducing initiation of antibiotic therapy, (2) focus on shortening duration of antibiotic therapy, (3) various organizational stewardship implementations. The heterogeneity of cohort composition, of implemented actions and of outcome measures made meta-analysis inappropriate. We provide an overview of the reduction in antibiotic use achieved. Conclusion: Antibiotic stewardship programs can be effective for premature newborns especially when multifactorial and tailored to this population, focusing on reducing initiation or on shortening the duration of antibiotic therapy. Programs without specific measures were less effective.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Antibiotic Stewardship in Premature Infants: A Systematic Review

et al. 2020

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“…Kitano et al created new guidelines for initiation of antibiotic therapy, based on clinical status of mother and infant, sepsis score of the infant, blood culture results and time-progression of symptoms, and achieved a significant reduction in percentage of patients started on antibiotic therapy. 36 No sub-analysis of these subgroups was performed. Evaluation of "Clinical status" and "progression of symptoms" in premature infants are the more challenging parts of the tool.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic stewardship in premature infants: a systematic review

Rajar

Saugstad

Berild

et al. 2020

Preprint

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Antibiotic treatment in premature infants is often empirically prescribed, and practice varies widely among otherwise comparable neonatal intensive care units. Unnecessary and prolonged antibiotic treatment is documented in numerous studies. Recent research shows serious side effects and suggests long-term adverse health effects in prematurely born infants exposed to antibiotics in early life. One preventive measure to reduce unnecessary antibiotic exposure is implementation of antibiotic stewardship programs. We reviewed the literature on implemented antibiotic stewardship programs focusing on premature infants. Six academic databases were systematically searched and eleven articles met inclusion criteria. Articles were grouped according to common area of stewardship actions; 1) Focus on reducing initiation of antibiotic therapy, 2) Focus on shortening duration of antibiotic therapy, 3) Various infrastructural stewardship implementations. The studies differed in their cohort composition and measured outcomes. We provide an overview of the reduction in antibiotic use achieved. Antibiotic stewardship programs are effective especially when they use a multifactorial approach and are tailored to premature infants. Implementation of antibiotic stewardship programs targeting premature infants should be considered in all neonatal intensive care units. The Norwegian Research Council (project number 273833) and the Olav Thon Foundation supported the study.

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