Antibiotic Overuse in Premature Low Birth Weight Infants in a Developing Country

Rueda, Maria S; Calderón-Anyosa, Renzo; Gonzales, Jorge; Turin, Christie G.; Zea-Vera, Alonso; Zegarra, Jaime; Bellomo, Sicilia; Cam, Luis; Castañeda, Anne; Ochoa, Theresa J.

doi:10.1097/inf.0000000000002055

Cited by 17 publications

(15 citation statements)

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“…Importantly, hospitals that had an NICU-specific ASP had significantly lower antibiotic utilization rates. The importance of such a program cannot be over-emphasized as it ultimately may help to decrease antimicrobial resistance in NICUs worldwide [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] .…”

Section: Discussionmentioning

confidence: 99%

A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study

et al. 2021

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Background Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. Methods We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. Findings On July 1, 2019, 26% of infants (580/2,265; range, 0–100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received ≥1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were “rule-out” sepsis (32%) and “culture-negative” sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and “culture-negative” infections was 12 days (median; IQR, 8–14) and 7 days (median; IQR, 5–10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization ( p = 0·02). Interpretation Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide. Funding Merck & Co.; The Ohio State University College of Medicine Barnes Medical Student Research Scholarship

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Section: Discussionmentioning

confidence: 99%

A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study

et al. 2021

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“…[412] Direct and planned interventions to curb antibiotic overuse can create a considerable impact in controlling the increasing burden of bacterial resistance. [2] Increasing bacterial resistance and hospital costs have mandated the reevaluation of the duration of prescription. [112]…”

Section: Resultsmentioning

confidence: 99%

“…The measures to control antibiotic resistance became the need of the hour and several measures were taken up to control the same. [12]…”

Section: Introductionmentioning

confidence: 99%

Implications of Overprescription of Antibiotics: A Cross-Sectional Study

et al. 2019

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Introduction: The use of antibiotics in recent years has become more aggressive and more common. The inappropriate use, to be more precise, the abuse of these prescriptions, is the root cause for increasing bacterial resistance and adverse outcomes. Antisepsis can be suggested as an appropriate alternative to antibiotics, to control the increasing antibiotic resistance among individuals. Objective: The objective of this study was to compare the awareness of antibiotic prescription and resistance among BDS and MDS practitioners and students. Materials and Methods: A total of 361 dental professionals were included in this study. Each of them was given a questionnaire containing questions pertaining to antibiotic prescription and awareness. Results: Most of the participants prescribed antibiotics as pre and post treatment management of all the oral diseases during their routine interaction with the patients. Overprescription of antibiotics, amoxicillin being the most common, was significantly more among the BDS practitioners than the MDS practitioners. BDS practitioners (78%) preferred a 3-day antibiotic prescription whereas MDS practitioners (80%) prescribed a 5-day course, which was statistically significant. Mindfulness with respect to antimicrobial prophylaxis and antibiotic resistance was observed to be satisfactory in both the groups. However, there was a general absence of mindfulness with respect to the rules for antibiotic prescription recommendations in both the groups. Conclusion: Antibiotic prescription should be given with care to prevent its resistance, an upcoming iatrogenic health hazard.

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“…(26)(27)(28) Lo más preciso es que un examen físico normal y un RN asintomático tienen un elevado valor clínico con muy buen valor predictivo para saber casi con certeza que la sepsis no está presente. (9)(10)(11)20,(26)(27)(28) Si bien es cierto que puede ocurrir bacteriemia en ausencia de signos clínico, esto es muy infrecuente y más aún si al evaluar al RN en forma sistemática y con la frecuencia necesaria siempre continúa con examen físico normal y asintomático. Asimismo, la evaluación frecuente del RN es crítica para reconocer los signos y síntomas que pueden variar de no específicos a fallo multiorgánico.…”

Section: La Clínica Neonatal Y La Sospecha De Sepsisunclassified

Suspected Neonatal Sepsis: Tenth Clinical Consensus of the Ibero-American Society of Neonatology (SIBEN)

et al. 2020

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Suspected neonatal sepsis is one of the most common diagnoses made in newborns (NBs), but very few NBs actually have sepsis. There is no international consensus to clearly define suspected neonatal sepsis, but each time that this suspected diagnosis is assumed, blood samples are taken, venous accesses are used to administer antibiotics, and the mother-child pair is separated, with prolonged hospital stays. X-rays, urine samples, and a lumbar puncture are sometimes taken. This is of concern, as generally <10% and no more than 25%-30% of the NBs in whom sepsis is suspected have proven neonatal sepsis. It seems easy to start antibiotics with suspicion of sepsis, but stopping them is difficult, although there is little or no support to maintain them. Unfortunately, the abuse of antibiotics in inpatient and outpatient NBs is foolish. Its negative impact on neonatal health and the economy is a public health problem of epidemiological and even epidemic proportions. This manuscript is a shortened version of the 10 th Clinical Consensus of the Ibero-American Society of Neonatology (SIBEN) on suspected neonatal sepsis at the end of 2018, updated with publications from its completion to February 2020. This manuscript describes useful strategies for everyday neonatal practice when neonatal sepsis is suspected, along with important aspects about the indisputable value of clinical evaluation of the NB and about obtaining and interpreting blood cultures, urine cultures, and other cultures. Likewise, the low value of laboratory tests in suspected neonatal sepsis is demonstrated with evidence and clinical recommendations are made on the appropriate use of antibiotics. EDITOR'S NOTEIn 2003, a group of physicians in Latin America observed that there was a discrepancy between neonatal delivery of care and outcomes in the Latin American region compared with other areas of the world. They formed SIBEN, the Ibero-AUTHOR DISCLOSURE Dr Golombek has been a speaker for Mallinkrodt and has a grant from Chiesi. Dr Sola receives funding from Masimo. Drs Mir, Lemus, Fariña, and Ortiz have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

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Antibiotic Overuse in Premature Low Birth Weight Infants in a Developing Country

Abstract: Premature infants receive antibiotics for longer than recommended periods of time. Antibiotic overuse is greater in neonates with lower BW. Vancomycin is the most used antibiotic. There is an urgent need to develop antimicrobial stewardship programs in our setting.

Cited by 17 publications

References 30 publications

A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study

A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study

Implications of Overprescription of Antibiotics: A Cross-Sectional Study

Suspected Neonatal Sepsis: Tenth Clinical Consensus of the Ibero-American Society of Neonatology (SIBEN)

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