No abstract

GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. a Methods employed for randomisation and allocation concealment not explicitly stated in the study. Participant blinding not done. Downgraded for risk of bias. b The confidence interval of the estimate is imprecise. Downgraded for imprecision.

No abstract

No abstract

Background The overuse of antimicrobials in neonates is not uncommon and has resulted in a global health crisis of antibiotic resistance. Objectives To evaluate changes associated with a neonatologist-driven antibiotic stewardship program (ASP) in antibiotics usage. Study design We conducted a pre-post retrospective cohort study in a tertiary care hospital in Oman. Neonates admitted in 2014-2015 were considered as the pre-ASP cohort. In 2016, a neonatologist-driven ASP was launched in the unit. The program included the optimization and standardization of antibiotics use for early and late-onset sepsis using the CDC's "broad principles," an advanced antimicrobial decision-support system to resolve contentious issues, and greater emphasis on education and behavior modification. Data from the years 2016-2019 were compared with previous data. The outcome of interest included days of therapy (DOT) for antimicrobials. Baseline characteristics and outcomes were compared using standard statistical measures. Results The study included 2098 neonates in the pre-ASP period and 5464 neonates in the post-ASP period. There was no difference in baseline characteristics. The antibiotic use decreased from 752 DOT per 1000 patient-days (PD) in the pre-ASP period to 264 DOT in the post-ASP period (64.8% reduction, P < 0.001). The proportion of neonates who received any antibiotics declined by 46% (pre-ASP = 1161/2098, post-ASP = 1676/5464). The most statistically significant reduction in DOT per 1000 PD was observed in the use of cefotaxime (82%), meropenem (74%), and piperacillin-tazobactam (74%). There was no change in mortality, culture-positive microbial profile, or MDRO incidence in the post-ASP period. Conclusions: Empowering frontline neonatologists to drive ASP was associated with a sustained reduction in antibiotics utilization.