Antimicrobial Stewardship in Neonates: Challenges and Opportunities

Abstract

Neonatal infections result in significant morbidity and mortality. Antibiotics are vital for the treatment of infections but disrupt the neonatal microbiome, put the infant at risk for an adverse drug reaction, and may lead to the development of antibiotic resistance. Immediately after birth, clinicians must determine which infants require empiric antibiotics. Online risk stratification tools may provide a superior approach to decision trees. In infants who require empiric therapy for early-onset sepsis, ampicillin and an aminoglycoside with dosing based on recent pharmacokinetic studies represents the most appropriate first-line agents; third-generation cephalosporins should be reserved for patients with a high likelihood of Gram-negative meningitis. An antistaphylococcal penicillin and gentamicin should be utilized for suspected late-onset sepsis. Vancomycin and other broad-spectrum agents are reserved for patients with a history of resistant organisms. Antibiotic duration should be guided by understanding the clinical indications and obtaining the necessary cultures appropriately (i.e., adequate volume blood cultures). In the absence of a positive culture, antibiotic duration should often be limited. Individual institutions should leverage a multidisciplinary, interprofessional team to identify opportunities for antimicrobial stewardship. A collaborative, transparent system is required to change unit culture and generate a sustained impact on antibiotic utilization with optimal patient outcomes.

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

“…If screening is necessary, then antibiotics are started empirically whilst waiting for test results. For those who have been started empirically on antibiotics, the shortest possible course should be used and stopping after 36 h is achievable and considered good practice [160]. …”

Effectiveness of antimicrobial stewardship programmes in neonatology: a systematic review

“…However, antibiotic use in neonates is associated with short-term and long-term adverse consequences due to emerging AMR, both for the individual patient and neonatal settings as a whole. Often, pathogens of clinical bacterial infections are not identified in neonates, which limits targeted treatment; and thus, antibiotic prescriptions for clinical sepsis or suspected bacterial infections in neonates is often large 7…”

Controle de infecções relacionadas à assistência à saúde por bactérias Gram-negativas resistentes à carbapenêmicos em unidade de tratamento intensivo neonatal do Rio de Janeiro.

“…Additionally, restrictive antibiotic use policies have not impacted on increased patient mortality, as this issue is a pertinent concern of care teams, especially for critically ill newborns who often require broad spectrum treatment regimens. 8,14,[21][22][23] The study has some limitations, the first of which was carried out in a single center.…”