Antibiotic use for presumed neonatally acquired infections far exceeds that for central line-associated blood stream infections: an exploratory critique

Wirtschafter, David D.; Padilla, Guadalupe; Suh, Ok Kyung; Wan, KY; Trupp, D; Fayard, Elba

doi:10.1038/jp.2011.39

Cited by 37 publications

(40 citation statements)

References 38 publications

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“…Do NICUs vary widely in their use of antibiotics? It is difficult to generalize from the findings of Wirtschafter et al 3 However, it is known that antibiotic use varies widely across children's hospitals, even after adjusting for hospital-and patient-level demographic and clinical characteristics typically associated with appropriate antibiotic use. 8 If antibiotic use does vary widely among NICUs, how much is too muchFor too little?…”

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confidence: 42%

“…Of course, if appropriate antibiotic treatment correlated perfectly with documented infection then the investigative focus would be directed toward variation in infection ratesFalready a subject of much scrutiny, including by neonatal collaboratives across North America. 5,7,9 Furthermore, as Wirtschafter et al 3 demonstrate, treatment of definitive infections represents the minority of antibiotic use in the NICU population.…”

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confidence: 99%

“…To this end, in this issue Wirtschafter et al 3 invite reflection on how to measure how much, how often, and why antibiotics are used in the NICU. These investigators also highlight the relatively simplistic database design and analytical methods currently applied to such neonatal health services research.…”

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confidence: 99%

“…We know that wide variation in outcomes exists among NICUs. [4][5][6][7] Wirtschafter et al 3 direct our attention to the potentially wide variation in resource use among NICUs. The charge now is to build on current knowledge by connecting adjusted NICU resource use with NICU patient outcomes.…”

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confidence: 99%

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Metrics for NICU antibiotic use: which rate is right?

Schulman

Saiman

2011

J Perinatol

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confidence: 42%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Metrics for NICU antibiotic use: which rate is right?

Schulman

Saiman

2011

J Perinatol

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“…1,2 Unlike in children and adults, neonates often exhibit nonspecific clinical and laboratory signs, making it difficult to distinguish infections from other disease processes. 3,4 While timely interventions for a true infection are critical, repeated and unnecessary exposures to broad-spectrum antibiotics can result in the development of antimicrobial resistance among certain organisms, as well as an increased risk of candidemia, necrotizing enterocolitis (NEC), hospital-acquired infections, and death in preterm infants. [5][6][7][8][9][10][11][12][13] Organizations have published guidelines aimed at improving antibiotic prescription practices of healthcare providers and, based on these guidelines, some children's hospitals have successfully implemented antimicrobial stewardship programs (ASPs).…”

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confidence: 99%

Implementation of an Antimicrobial Stewardship Program in a Neonatal Intensive Care Unit

Nzegwu

Rychalsky

Nallu

et al. 2017

Infect. Control Hosp. Epidemiol.

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objective. To evaluate antimicrobial utilization and prescription practices in a neonatal intensive care unit (NICU) after implementation of an antimicrobial stewardship program (ASP).design. Quasi-experimental, interrupted time-series study.setting. A 54-bed, level IV NICU in a regional academic and tertiary referral center.patients and participants. All neonates prescribed antimicrobials from January 1, 2011, to June 30, 2016, were eligible for inclusion.intervention. Implementation of a NICU-specific ASP beginning July 2012.methods. We convened a multidisciplinary team and developed guidelines for common infections, with a focus on prescriber audit and feedback. We conducted an interrupted time-series analysis to evaluate the effects of our ASP. Our primary outcome measure was days of antibiotic therapy (DOT) per 1,000 patient days for all and for select antimicrobials. Secondary outcomes included provider-specific antimicrobial prescription events for suspected late-onset sepsis (blood or cerebrospinal fluid infection at >72 hours of life) and guideline compliance.results. Antibiotic utilization decreased by 14.7 DOT per 1,000 patient days during the stewardship period, although this decrease was not statistically significant (P = .669). Use of ampicillin, the most commonly antimicrobial prescribed in our NICU, decreased significantly, declining by 22.5 DOT per 1,000 patient days (P = .037). Late-onset sepsis evaluation and prescription events per 100 NICU days of clinical service decreased significantly (P < .0001), with an average reduction of 2.65 evaluations per year per provider. Clinical guidelines were adhered to 98.75% of the time.conclusions. Implementation of a NICU-specific antimicrobial stewardship program is feasible and can improve antibiotic prescribing practices.

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Antimicrobial dressings for the prevention of catheter-related infections in newborn infants with central venous catheters

Lai

Taylor

Tan

et al. 2016

Cochrane Database of Systematic Reviews

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Based on moderate-quality evidence, chlorhexidine dressing/alcohol skin cleansing reduced catheter colonisation, but made no significant difference in major outcomes like sepsis and CRBSI compared to polyurethane dressing/povidone-iodine cleansing. Chlorhexidine dressing/alcohol cleansing posed a substantial risk of contact dermatitis in preterm infants, although it was unclear whether this was contributed mainly by the dressing material or the cleansing agent. While silver-alginate patch appeared safe, evidence is still insufficient for a recommendation in practice. Future research that evaluates antimicrobial dressing should ensure blinding of caregivers and outcome assessors and ensure that all participants receive the same co-interventions, such as the skin cleansing agent. Major outcomes like sepsis, CRBSI and mortality should be assessed in infants of different gestation and birth weight.

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Antibiotic use for presumed neonatally acquired infections far exceeds that for central line-associated blood stream infections: an exploratory critique

Cited by 37 publications

References 38 publications

Metrics for NICU antibiotic use: which rate is right?

Metrics for NICU antibiotic use: which rate is right?

Implementation of an Antimicrobial Stewardship Program in a Neonatal Intensive Care Unit

Antimicrobial dressings for the prevention of catheter-related infections in newborn infants with central venous catheters

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