Reduction of Inappropriate Antimicrobial Prescriptions in a Tertiary Neonatal Intensive Care Unit After Antimicrobial Stewardship Care Bundle Implementation

Ting, Joseph; Paquette, Vanessa; Ng, Karen; Lisonkova, Sarka; Hait, Valoria; Shivanada, Sandesh; Tilley, Peter; Osiovich, Horacio; Roberts, Ashley

doi:10.1097/inf.0000000000002039

Cited by 50 publications

(50 citation statements)

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“…A total of 118 full-text articles were reviewed, of which six were eligible for final analysis. Four articles were from the USA,12–15 one from Canada and one from Ireland 16 17. All articles fulfilled the minimum and mandatory ICROMS quality criteria (scores for each article according to the ICROMS methodology are presented in online supplementary annex 1-3).…”

Section: Resultsmentioning

confidence: 99%

“…Interventions in neonates only were conducted exclusively in NICUs 12 13 15–17. One article addressed interventions to the NICU, the paediatric intensive care unit (PICU) and the cardiac intensive care unit 14…”

Section: Resultsmentioning

confidence: 99%

“…ASPs of four studies used a multimodal implementation strategy,13 14 16 17 while a single ASP intervention was tested in the other two studies 12 15 Table 1. summarises the findings of the six articles.…”

Section: Resultsmentioning

confidence: 99%

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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: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Effectiveness of antimicrobial stewardship programmes in neonatology: a systematic review

et al. 2020

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“…However, they observed a changed profile of antibiotic consumption: an increase in the use of ampicillin and gentamicin, and a decrease in the use of betalactamase inhibitors, macrolides and meropenem. 25 42 They compared a pre-ASP and a post-ASP cohort and found a reduction in inappropriate courses of therapy with meropenem, vancomycin, cefotaxim and linezolid.…”

Section: Resultsmentioning

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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“…Although other outcomes were not investigated in this study, it is safe to assume that with this intervention, antibiotic-related adverse events, the prevalence of resistant microorganisms, and antibiotic costs would also have decreased. Several studies have demonstrated a decrease in inappropriate antibiotic usage with the implementation of an ASP (Chrysou et al, 2018;Ting et al, 2018). Chrysou et al found that after implementing an ASP, total antibiotic use decreased by 16.7% owing to a 19.1% reduction in unrestricted antibiotics and 13.8% in restricted antibiotics (Chrysou et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

The need for an antibiotic stewardship program in a hospital using a computerized pre-authorization system

Şengel

Bilgin

et al. 2019

International Journal of Infectious Diseases

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Objectives: Antimicrobial stewardship programs (ASPs) have an important role in the appropriate utilization of antibiotics. Some of the core strategies recommended for ASPs are pre-authorization and prospective audit and feedback. In Turkey, a unique nationwide antibiotic restriction program (NARP) has been in place since 2003. The aim of this study was to measure the effect of a prospective audit and feedback strategy system along with the NARP. Methods: A prospective quasi-experimental study was designed and implemented between March and June 2017. A computerized pre-authorization system was used as an ASP strategy to approve the antibiotics. During the baseline period, patients with intravenous (IV) antibiotic use 72 h were monitored without intervention. In the second period, feedback and treatment recommendations were given to attending physicians in the case of IV antibiotic use 72 h. The modified criteria of Kunin et al. and Gyssens et al. were followed for appropriateness of prescribing. Days of therapy (DOT) and length of stay (LOS) were calculated and compared between the two study periods. Results: A total of 866 antibiotic episodes among 519 patients were observed. A significant reduction in systemic antibiotic consumption was observed in the intervention period (575 vs. 349 DOT per 1000 patient-days; p < 0.001). On multivariate analysis, prospective audit and feedback (odds ratio 1.5, 95% confidence interval 1.09-2.04; p = 0.011) and pre-authorization of restricted antibiotics (odds ratio 1.7; 95% confidence interval 1.2-2.31; p = 0.002) were the predictors of appropriate antimicrobial use. Mean LOS was decreased by 2.9 days (p = 0.095). Conclusions: This study showed that the antimicrobial restriction program alone was effective, but the system should be supported by a tailored ASP, such as prospective audit and feedback.

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Reduction of Inappropriate Antimicrobial Prescriptions in a Tertiary Neonatal Intensive Care Unit After Antimicrobial Stewardship Care Bundle Implementation

Abstract: In this study, we found that ASP initiatives can be applied in neonatal populations to reduce inappropriate antimicrobial prescriptions, though a different approach may be needed among VLBW infants.

Cited by 50 publications

References 35 publications

Effectiveness of antimicrobial stewardship programmes in neonatology: a systematic review

Effectiveness of antimicrobial stewardship programmes in neonatology: a systematic review

Antibiotic stewardship in premature infants: a systematic review

The need for an antibiotic stewardship program in a hospital using a computerized pre-authorization system

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