Antibiotic stewardship in premature infants: a systematic review

Rajar, Polona; Saugstad, Ola Didrik; Berild, Dag; Dutta, Anirban; Greisen, Gorm; Lausten-Thomsen, Ulrik; Mande, Sharmila S.; Nangia, Sushma; Petersen, Fernanda Cristina; Dahle, Ulf R.; Haaland, Kirsti

doi:10.1101/2020.04.10.20060988

Cited by 5 publications

(5 citation statements)

References 72 publications

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“…To our knowledge, this is the first systematic review that has focused on the implementation of ASPs in paediatrics globally, both in the ED and primary care. In the last 2 years, other systematic reviews about the implementation of PASPs were published, one in premature infants, 77 and the other in PED, but only for respiratory infections. 78 In addition, another recently published review focused on PASP implementation in low- and middle-income countries.…”

Section: Discussionmentioning

confidence: 99%

The impact of Antimicrobial Stewardship Programmes in paediatric emergency departments and primary care: a systematic review

Brigadoi

Rossin

Visentin

et al. 2023

Therapeutic Advances in Infection

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Background: Antibiotics remain the most prescribed medicine in children worldwide, but half of the prescriptions are unnecessary or inappropriate, leading to an increase in antibiotic resistance. This study aims to systemically review the effects of different Antimicrobial Stewardship Programmes (ASPs) on reducing the rates of both antibiotic prescriptions and changes in antimicrobial resistance, and on the economic impact in paediatric emergency departments (PED) and primary care settings. Materials and methods: Embase, MEDLINE, and Cochrane Library were systematically searched, combining Medical Subject Heading and free-text terms for ‘children’ and ‘antimicrobial’ and ‘stewardship’. The search strategy involved restrictions on dates (from 1 January 2007 to 30 December 2020) but not on language. Randomized controlled trials, controlled and non-controlled before and after studies, controlled and non-controlled interrupted time series, and cohort studies were included for review. The review protocol was registered at the PROSPERO International Prospective Register of Systematic Reviews: Registration Number CRD42021270630. Results: Of the 47,158 articles that remained after removing duplicates, 59 were eligible for inclusion. Most of the studies were published after 2015 (37/59, 62.7%) and in high-income countries (51/59, 86.4%). Almost half of the studies described the implementation of an ASP in the primary care setting (28/59, 47.5%), while 15 manuscripts described the implementation of ASPs in EDs (15/59, 25.4%). More than half of the studies (43/59, 72.9%) described the implementation of multiple interventions, whereas few studies considered the implementation of a single intervention. Antibiotic prescriptions and compliance with guidelines were the most frequent outcomes (47/59, 79.7% and 20/59, 33.9%, respectively). Most of the articles reported an improvement in these outcomes after implementing an ASP. Meanwhile, only very few studies focused on health care costs (6/59, 10.2%) and antimicrobial resistance (3/59 5.1%). Conclusion: The implementation of ASPs has been proven to be feasible and valuable, even in challenging settings such as Emergency Departments and Primary care.

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Section: Discussionmentioning

confidence: 99%

The impact of Antimicrobial Stewardship Programmes in paediatric emergency departments and primary care: a systematic review

Brigadoi

Rossin

Visentin

et al. 2023

Therapeutic Advances in Infection

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“…In addition, the amount of potentially pathogenic bacteria in these infants is increased, and the amount of essential commensal bacteria is decreased [84,85]. Premature or low birth weight infants are at the highest risk for antibiotic-related disorders because they typically receive antibiotic treatment at birth to protect them from bacterial infections and earlyonset sepsis [86][87][88]. Antibiotic use has destructive effects such as reducing the bacterial diversity of the gut microbiota of these infants [88].…”

Section: Preterm Delivery and Antibiotic Treatmentmentioning

confidence: 99%

The Effect of COVID-19 Pandemic on the Infants’ Microbiota and the Probability of Development of Allergic and Autoimmune Diseases

Ebrahimi

Khatami

Mesdaghi

2021

Int Arch Allergy Immunol

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The human microbiota plays a significant role in various mechanisms of the body. The formation of a healthy microbiota, especially in early childhood, has a significant effect on maintaining human health. Since the onset of coronavirus disease 2019 (COVID-19), the disease has caused many changes in human life. According to the available information, many of these factors affect the composition and diversity of the body’s microbiota, so this pandemic may alter and disrupt the microbiota and consequently increase the incidence of other diseases such as allergic and autoimmune disorders, especially in children and infants born in this era. In this review, the probable impact of the COVID-19 pandemic on body’s microbiota and its relationship with the emergence of future diseases is discussed.

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“…We thank Marie Susanna Isachsen from the University of Oslo library for helping with the protocol for the literature search. This manuscript has been previously published on a preprint server [49].…”

Section: Acknowledgementsmentioning

confidence: 99%

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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Antibiotic stewardship in premature infants: a systematic review

Cited by 5 publications

References 72 publications

The impact of Antimicrobial Stewardship Programmes in paediatric emergency departments and primary care: a systematic review

The impact of Antimicrobial Stewardship Programmes in paediatric emergency departments and primary care: a systematic review

The Effect of COVID-19 Pandemic on the Infants’ Microbiota and the Probability of Development of Allergic and Autoimmune Diseases

Antibiotic Stewardship in Premature Infants: A Systematic Review

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