Antimicrobial stewardship intervention to reduce unnecessary antibiotic doses in neonates

Newby, Brandi; Mok, Sandy H.S.; Sun, Yi

doi:10.1016/j.ajic.2020.06.177

Cited by 6 publications

(7 citation statements)

References 10 publications

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“…Antibiotics are commonly used in the neonatal unit, and ampicillin [24] and gentamycin were used in 72.9% of cases in our study, similar to the Newby et al study [25]. From our study, the causative organisms in early-onset sepsis were mainly GBS and congenital syphilis, while gram-negative organisms caused HAI.…”

Section: Discussionsupporting

confidence: 85%

“…Using the Essential Medicine List Classi cation for Children (EMLc), our study did not have any babies in the restricted antibiotics group, contrary to the study performed by Hsia Y et al [4]. This difference may be attributed to strict adherence (100% postintervention) to the MMH unit's neonatal treatment guidelines and a low rate of HAI when compared to many LMIC neonatal units [34][35][36][37].…”

Section: Discussioncontrasting

confidence: 65%

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Strengthening Antibiotics Stewardship at Mowbray Maternity Hospital– Neonatal Unit.

Mkony,

VanNiekerk,

Shabani

et al. 2024

Preprint

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Objective To assess antimicrobial usage, prescription practices, sensitivity patterns, hand hygiene (HH) practices and adherence to antibiotic stewardship principles in the neonatal unit at Mowbray Maternity Hospital (MMH). Study design: A mixed method observational study was performed at MMH. A point of prevalence survey to assess antibiotic stewardship and HH audits was conducted using the WHO tools in two phases, a baseline in December 2020. The findings of this baseline audit were presented to the Health Care Workers (HCW) and small-group HH training was done with all HCWs (day- and night-shift), representing the intervention. This was followed by a post-intervention audit from March to May 2021. Results: A total of 246 neonatal unit patient folders were reviewed between December 2020 and May 2021. At baseline, compliance with treatment guidelines was 90%, which improved to 100% postintervention. We found that 37 (15.0%) babies were on antibiotics, with 64.9% of those on first-line antibiotics (Access group). Using multivariate logistic regression, extremely preterm infants were more likely to be on antibiotics, with an odds ratio of 11, which was statistically significant. We found eight positive blood cultures (18.9%), which included one carbapenem-resistant enterococci, Klebsiella pneumoniae. For HH, a total of 444 opportunities were observed. Moment 5 had the lowest overall mean compliance of 57.4%, which was statistically significant with a p-value =0.0172. Conclusion: Strict adherence to treatment guidelines and good HH are essential factors for the good antibiotic stewardship seen at the MMH neonatal unit. This was reflected by low antibiotic usage, good HH compliance and a low HAI rate. Further improvement requires ongoing HH audits and training, especially focusing on HH moment 5, after touching the patient's surroundings.

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Section: Discussionsupporting

confidence: 85%

Section: Discussioncontrasting

confidence: 65%

Strengthening Antibiotics Stewardship at Mowbray Maternity Hospital– Neonatal Unit.

Mkony,

VanNiekerk,

Shabani

et al. 2024

Preprint

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“…Finally, 19 studies were included in this systematic review and meta-analysis (Figure 1). [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]…”

Section: Literature Search Resultsmentioning

confidence: 99%

“…Inappropriate antibiotic use was reported in four studies 26,31,35,36 : redundant antibiotic use, unnecessary antibiotic dosing, inappropriate prescription, and inappropriate indication or duration of antibiotic therapy. ASP implementation resulted in decreased redundant antibiotic use, unnecessary antibiotic dosing, and inappropriate prescription or duration of antibiotic therapy by 72.7%, 85.6%, and 48.4%‐62.6%, respectively, compared to those in the pre‐ASP period.…”

Section: Resultsmentioning

confidence: 99%

Impact of pharmacist intervention in antibiotic stewardship programmes for critically ill neonates: A systematic review and meta‐analysis

Lee

2021

Clinical Pharmacy Therapeu

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What is known and objective Antibiotic stewardship programmes (ASPs) are introduced to ensure effective antibiotic use. Pharmacists can be involved in ASPs to facilitate the appropriate antibiotic use. Prolonged use of antibiotics causes adverse events in critically ill neonates. Hence, this systematic review and meta‐analysis was aimed at investigating pharmacists’ functions in ASPs in critically ill neonates and the effect of ASP implementation on antibiotic use. Methods A comprehensive search of PubMed/Medline, Embase, and Cochrane Library databases until January 2021 was conducted and studies that reported the functions of pharmacists in ASPs for critically ill neonates and the results of ASP implementation were included in this review. All processes were performed by two reviewers independently, and any discordance between the two was resolved by discussion. Results and discussion In all, 19 studies were included in this review. Pharmacists were found to have various functions in ASPs, such as participating in the development of antibiotic use guidelines, auditing antibiotic prescriptions, participating in multidisciplinary ward rounds, educating other ASP team members, checking blood culture or laboratory data, and monitoring antibiotic use. A meta‐analysis revealed that ASP implementation in critically ill neonates was significantly associated with a 23% reduction in the overall antibiotic use rate (ratio of means: 0.77, 95% confidence interval: 0.69–0.87, p < 0.001). Moreover, the overall duration of antibiotic therapy significantly reduced by 15% with ASP implementation (ratio of means: 0.85, 95% confidence interval: 0.78–0.91, p < 0.001). What is new and conclusion The implementation of ASPs involving pharmacists, especially in critically ill neonates, was associated with the reduced use and duration of antibiotic treatment. Thus, pharmacists played a key role in ASPs in critically ill neonates.

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“…In a British Columbia referral hospital, almost 75% of very-preterm and low-birth-weight babies received antibiotics. They could reduce antibiotic administration beyond 48 h from 50% to 7.2% auditing blood culture reports for continuing antibiotics [2]. Indiscriminate use of antibiotics for longer periods than required will result in drug resistance, side effects related to medication, and superimposed infection with other bacteria and fungi.…”

mentioning

confidence: 99%

Fine-Tuning the Duration of Antibiotic Therapy for Neonatal Sepsis

Ballambattu

2022

Indian J Pediatr

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Antimicrobial stewardship intervention to reduce unnecessary antibiotic doses in neonates

Cited by 6 publications

References 10 publications

Strengthening Antibiotics Stewardship at Mowbray Maternity Hospital– Neonatal Unit.

Strengthening Antibiotics Stewardship at Mowbray Maternity Hospital– Neonatal Unit.

Impact of pharmacist intervention in antibiotic stewardship programmes for critically ill neonates: A systematic review and meta‐analysis

Fine-Tuning the Duration of Antibiotic Therapy for Neonatal Sepsis

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