Antimicrobial Stewardship in the Neonatal Intensive Care Unit: An Update

Gkentzi, Despoina; Dimitriou, Gabriel

doi:10.2174/1573396315666190118101953

Cited by 26 publications

(21 citation statements)

References 51 publications

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“…Culture-confirmed early-onset sepsis is not frequent, particularly not in term infants 39. Targeting or discontinuing antibiotics is challenging in neonates due to the unreliability of blood culture sampling in this population 40 41. In the absence of reliable markers to guide antibiotic therapy, effects of ASPs are limited in neonates.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of antimicrobial stewardship programmes in neonatology: a systematic review

et al. 2020

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IntroductionAntimicrobial stewardship programmes (ASPs) are recommended to improve antibiotic use in healthcare and reduce antimicrobial resistance (AMR). Our aim was to investigate the effectiveness of ASPs in reducing antibiotic consumption, use of broad-spectrum/restricted antibiotics, antibiotic resistance and healthcare-associated infections (HAIs) in neonates.MethodsWe searched PUBMED, SCIELO, EMBASE and the Cochrane Database (January 2000–April 2019) to identify studies on the effectiveness of ASPs in neonatal wards and/or neonatal intensive care units (NICUs). Outcomes were as follows: reduction of antibiotic consumption overall and of broad-spectrum/target antibiotics, inappropriate antibiotic use, antibiotic resistance and HAIs. ASPs conducted in settings other than acute care hospitals, for children older than 1 month, and ASPs addressing antifungal and antiviral agents, were excluded.ResultsThe initial search identified 53 173 titles and abstracts; following the application of filters and inclusion criteria, a total of six publications were included in the final analysis. All studies, of which one was multi-centre study, were published after 2010. Five studies were conducted exclusively in NICUs. Four articles applied multimodal interventions. Reduction of antibiotic consumption overall and/or inappropriate antibiotic use were reported by four articles; reduction of broad-spectrum/targeted antibiotics were reported by four studies; No article evaluated the impact of ASPs on AMR or the incidence of HAI in neonates.ConclusionASPs can be effectively applied in neonatal settings. Limiting the use of broad-spectrum antibiotics and shorting the duration of antibiotic treatment are the most promising approaches. The impact of ASPs on AMR and HAI needs to be evaluated in long-term studies.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of antimicrobial stewardship programmes in neonatology: a systematic review

et al. 2020

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“…13,32,34 Neonatologists Antibiotics are the most frequently utilized medications in neonatal intensive care units (NICUs). 35,38 Clinicians in NICUs encounter challenges unique to the neonatal population that can complicate antimicrobial treatment decisions. Neonates can exhibit non-specific clinical symptoms like apnea, respiratory distress and hypotension that can be seen with neonatal sepsis but which can also be non-infectious sequelae of premature birth.…”

Section: Hospitalistsmentioning

confidence: 99%

<p>Pediatric Antimicrobial Stewardship Programs: Current Perspectives</p>

Klatte

2020

PHMT

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With the rapid growth of the field of pediatric antimicrobial stewardship, there has been a marked increase in the establishment of programs dedicated to this specialty. Shared objectives of all pediatric antimicrobial stewardship programs (ASPs) include optimization of antibiotic use and improvement in clinical outcomes for children, while certain core operational strategies and metrics used to measure program effectiveness are typically utilized by pediatric ASPs. Antimicrobial stewardship is the responsibility of every individual who prescribes, dispenses, and administers antibiotics to children, and pediatric ASP principles are rooted in collaboration and cooperation. Pediatric ASPs are uniquely suited to meet the needs of the local populations they serve and the environments within which they practice while also fostering an awareness of the interconnected global nature of pediatric stewardship. As such, pediatric ASPs are well positioned to confront the evolving challenges of antimicrobial overuse and resistance.

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“…Unnecessary exposure to extended courses of antibiotic regimens in NICUs is common practice, despite good evidence that symptoms encountered in neonatal sepsis have several mimickers [ 6 ]. Stewardship interventions leading to profound declines in overall antibiotic use (up to 27%), even when including all admissions, have previously been described.…”

Section: Discussionmentioning

confidence: 99%

“…Antibiotics are the most commonly prescribed medications in Neonatal Intensive Care Units (NICUs) due to several predisposing factors associated with this group of patients, such as natural susceptibility to infections, prematurity, and birth-related complications, as well as postpartum events [ 6 ]. Variation in antibiotic use is also common among different NICUs [ 7 ], indicating the lack of robust evidence on appropriate indication for initiation, dosing and duration of therapy.…”

Section: Introductionmentioning

confidence: 99%

Reducing Duration of Antibiotic Use for Presumed Neonatal Early-Onset Sepsis in Greek NICUs. A “Low-Hanging Fruit” Approach

Kopsidas

Tsopela²,

Molocha³

et al. 2021

Antibiotics

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Antibiotics are commonly prescribed in Neonatal Intensive Care Units (NICU), where stewardship interventions are challenging. Lowering antibiotic consumption is desperately needed in Greece, a country with high antibiotic resistance rates. We sought to assess the effectiveness of a low-cost and -resource intervention to reduce antibiotic use in Greek NICUs implementing a “low-hanging fruit” approach. A prospective quasi-experimental study was conducted in 15/17 public NICUs in Greece (9/2016–06/2019). The intervention selected was discontinuation of antibiotics within 5 days for neonates with gestational age ≥ 37 weeks, no documented signs or symptoms of sepsis, CRP ≤ 10 mg/L and negative cultures within 3 days of antibiotic initiation. Impact was evaluated by the percentage of discontinued regimens by day 5, length of therapy (LOT) and stay. Trends of antibiotic consumption were assessed with days of therapy (DOT) per 1000 patient-days. Overall, there was a 9% increase (p = 0.003) of antibiotic discontinuation in ≤5 days. In total, 7/13 (53.8%) units showed a ≥10% increase. Overall, 615 days on antibiotics per 1000 patients were saved. Interrupted time-series analysis established a declining trend in DOT/1000 patient-days relative to the pre-intervention trend (p = 0.002); a monthly decrease rate of 28.96 DOT/1000 patient-days (p = 0.001, 95%CI [−45.33, −12.60]). The intervention had no impact on antibiotic choice. Antibiotic use was successfully reduced in Greek NICUs using a “low-hanging fruit” approach. In resource-limited settings, similar targeted stewardship interventions can be applied.

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Antimicrobial Stewardship in the Neonatal Intensive Care Unit: An Update

Cited by 26 publications

References 51 publications

Effectiveness of antimicrobial stewardship programmes in neonatology: a systematic review

Effectiveness of antimicrobial stewardship programmes in neonatology: a systematic review

<p>Pediatric Antimicrobial Stewardship Programs: Current Perspectives</p>

Reducing Duration of Antibiotic Use for Presumed Neonatal Early-Onset Sepsis in Greek NICUs. A “Low-Hanging Fruit” Approach

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