Antibiotic Use in Very Low Birth Weight Neonates After an Antimicrobial Stewardship Program

Berardi, Alberto; Zinani, Isotta; Rossi, Cecilia; Spaggiari, Eugenio; D'Amico, Virginia; Toni, Greta; Bedetti, Luca; Lucaccioni, Laura; Lugli, Licia

doi:10.3390/antibiotics10040411

Cited by 11 publications

(15 citation statements)

References 31 publications

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“…First, we separately analyzed the effect of the interventions to reduce the AUR for EOS and LOS. Second, we did not continue antibiotic treatment for newborns with presumptive EOS who were clinically stable with negative blood culture after 24 hours, as opposed to other QI investigators who wait until 36 hours 21 or 48 hours 30 , 31 hours for antibiotic discontinuation. Our admission order set included the administration of 2 doses of ampicillin and one dose of gentamicin.…”

Section: Discussionmentioning

confidence: 99%

New strategies to Reduce Unnecessary Antibiotic Use in the NICU: A Quality Improvement Initiative

Pantoja,

Sveum,

Frost

et al. 2023

Pediatric Quality &Amp; Safety

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Introduction: Early-onset sepsis (EOS) and late-onset Sepsis (LOS) are common diagnoses entertained in sick newborns treated in neonatal intensive care units (NICUs), and antibiotics are the medications most prescribed in NICUs. Antibiotic stewardship programs have an important impact on limiting unnecessary antibiotic use. Methods: Following the Model for Improvement, between 2/1/16 and 1/31/17, at a level 3 NICU, a multidisciplinary team implemented PDSA cycles to promote antibiotic stewardship practices for newborns at risk of EOS and LOS. The main goal was to decrease the antibiotic usage rate (AUR) safely. Primary strategies included discontinuing antibiotics within 24 hours of life if the newborn was stable, and the blood culture was negative for EOS and implementing an “antibiotic time-out” during rounds. Results: For all newborns admitted to our NICU, the AUR decreased, for EOS from 137 to 32 days per 1000 patient days (77% reduction) and for LOS from 277 to 121 days per 1000 patient days (56% reduction). We demonstrated the sustainability of both EOS-AUR and LOS-AUR during the 2 years postcompletion of the intervention period. There were no adverse effects of reducing the AUR. Conclusion: Interventions that reduce unnecessary antibiotic use in the NICU are safe and prevent excessive antibiotic exposure.

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Section: Discussionmentioning

confidence: 99%

New strategies to Reduce Unnecessary Antibiotic Use in the NICU: A Quality Improvement Initiative

Pantoja,

Sveum,

Frost

et al. 2023

Pediatric Quality &Amp; Safety

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“…Additional laboratory tests at the onset and subsequent laboratory monitoring were at the discretion of the attending physician, depending on the preceding test findings and the patient’s clinical condition. According to our local protocol of antimicrobial stewardship [ 31 ], broad-spectrum antibiotics (including oxacillin plus an aminoglycoside) were given and discontinued within 48 h if sepsis was ruled out. Empiric antibiotic treatment was not necessarily given after the collection of a blood culture.…”

Section: Methodsmentioning

confidence: 99%

Late-Onset Sepsis Mortality among Preterm Infants: Beyond Time to First Antibiotics

et al. 2023

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Objective: To investigate the impact of timing, in vitro activity and appropriateness of empirical antimicrobials on the outcome of late-onset sepsis among preterm very low birth weight infants that are at high risk of developing meningitis. Study design: This retrospective study included 83 LOS episodes in 73 very low birth weight infants born at ≤32 weeks’ gestation with positive blood and/or cerebrospinal fluid culture or polymerase chain reaction at >72 h of age. To define the appropriateness of empirical antimicrobials we considered both their in vitro activity and their ideal delivery through the blood-brain barrier when meningitis was confirmed or not ruled out through a lumbar puncture. The primary outcome was sepsis-related mortality. The secondary outcome was the development of brain lesions. Timing, in vitro activity and appropriateness of empirical antimicrobials, were compared between fatal and non-fatal episodes. Uni- and multi-variable analyses were carried out for the primary outcome. Results: Time to antibiotics and in vitro activity of empirical antimicrobials were similar between fatal and non-fatal cases. By contrast, empirical antimicrobials were appropriate in a lower proportion of fatal episodes of late-onset sepsis (4/17, 24%) compared to non-fatal episodes (39/66, 59%). After adjusting for Gram-negative vs. Gram-positive pathogen and for other supportive measures (time to volume administration), inappropriate empirical antimicrobials remained associated with mortality (aOR, 10.3; 95% CI, 1.4–76.8, p = 0.023), while timing to first antibiotics was not (aOR 0.9; 95% CI, 0.7–1.2, p = 0.408; AUC = 0.88). The association between appropriate antimicrobials and brain sequelae was also significant (p = 0.024). Conclusions: The risk of sepsis-related mortality and brain sequelae in preterm very low birth weight infants is significantly associated with the appropriateness (rather than the timing and the in vitro activity) of empirical antimicrobials. Until meningitis is ruled out through lumbar puncture, septic very low birth weight infants at high risk of mortality should receive empiric antimicrobials with high delivery through the blood-brain barrier.

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“…Furthermore, an AMS program for EOS and LOS was first introduced at the end of 2014. Since 2016, this has been implemented in the NICU [35] and then shared with the entire region, following repeated audits and meetings, with discussion of the available literature [34].…”

Section: Study Design Population and Settingmentioning

confidence: 99%

Antimicrobial Resistance Pattern and Empirical Antibiotic Treatments in Neonatal Sepsis: A Retrospective, Single-Center, 12-Year Study

Minotti,

Di Caprio,

Facchini

et al. 2023

Antibiotics

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Neonatal sepsis is an important cause of morbidity and mortality in neonatal intensive care units (NICUs). Continuous evaluation of antimicrobial resistance (AMR) profiles is advised to implement antimicrobial stewardship (AMS) programs and establish effective empiric antibiotic protocols. AMS may reduce AMR in NICUs and improve sepsis outcomes. In this retrospective observational study, we report data on culture-positive neonatal sepsis, assessing differences after the implementation of an AMS program (2011–2016 vs. 2017–2022). A total of 215 positive bacterial cultures from 169 infants were retrieved, with 79 early-onset (36.7%) and 136 late-onset (63.3%) sepsis episodes. Frequent causative agents for early-onset sepsis were S. agalactiae and E. coli, all susceptible to empiric treatment. Late-onset sepsis was mainly caused by Enterobacterales and S. aureus. Aminoglycosides, cefotaxime, and piperacillin-tazobactam resistance among Enterobacterales was substantially low; S. aureus was mostly susceptible to oxacillin and vancomycin. There were no differences in mortality and multidrug-resistant pathogens rates between the two study periods. There were five episodes of fungal late-onset sepsis, mostly due to C. albicans, of which one was fatal. The microbial distribution pattern and AMR profiles overlapped with other European studies. Because susceptibility patterns are rapidly changing worldwide, with the emerging threat of Methicillin-resistant S. aureus and extended-spectrum beta-lactamases producers, infection prevention and control practices and AMS strategies require continuous optimization to limit selection pressure and AMR escalation.

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Antibiotic Use in Very Low Birth Weight Neonates After an Antimicrobial Stewardship Program

Cited by 11 publications

References 31 publications

New strategies to Reduce Unnecessary Antibiotic Use in the NICU: A Quality Improvement Initiative

New strategies to Reduce Unnecessary Antibiotic Use in the NICU: A Quality Improvement Initiative

Late-Onset Sepsis Mortality among Preterm Infants: Beyond Time to First Antibiotics

Antimicrobial Resistance Pattern and Empirical Antibiotic Treatments in Neonatal Sepsis: A Retrospective, Single-Center, 12-Year Study

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