Antimicrobial Stewardship in the Neonatal Intensive Care Unit (NICU): Building and Sustaining the Effective Collaboration

Mongkolrattanothai, Kanokporn; Chin, Steven; Nair, Sreejayan; Lin, Ting‐Yi; Holmen, Jenna; Gentry, Matthew; Luu, Michael

doi:10.1093/ofid/ofw172.1462

Cited by 3 publications

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“…21 Studies looking that the effectiveness of ASPs in the NICU, the effect of interprovider variability on adherence to ASP guidelines, and the potential adverse outcomes when there is deviation from ASP guidelines demonstrate the importance of being thoughtful when deciding whether to give antibiotic therapy to neonates. [22][23][24] Although the effects of early antibiotic use in premature infants on growth and metabolic changes have yet to be fully elucidated, this study explores another reason to be judicious with the administration of antibiotics in neonates. Future steps involve a prospective study with a larger sample size, postdischarge follow-up, and infants of lower GA. Metabolomic analysis of urine and stool samples may help determine functional changes from antibiotic exposure.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Early Antibiotic Exposure and Short-Term Growth Velocity in Premature Neonates

et al. 2018

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Objective To characterize the relationship between the duration of antibiotic administration during the first week of life and subsequent growth velocity during hospitalization. Study Design This was a retrospective study comparing the inhospital growth of infants born between 30 and 326/7 weeks' gestational age (GA) admitted to the Montefiore Weiler and Wakefield neonatal intensive care units between January 2009 and December 2015. Antibiotic duration during the first week of life was classified as no antibiotics, <5 days of antibiotics, or ≥5 days of antibiotics. Differences between discharge and birth weight Z-scores were compared between the three groups using analysis of variance. Results Of the infants, 87% received antibiotics during the first week of life, with 16% of infants completing ≥5 days. Compared with infants receiving ≤ 5 days of antibiotics, infants treated with ≥5 days had a lower GA, lower Apgar scores, more invasive respiratory support, longer duration of total parenteral nutrition, delayed initiation of enteral feeding, and a higher weight Z-score on admission and discharge (p < 0.05). However, there was no distinction in growth between the three groups assessed by the difference between admission and discharge weight Z-scores (p = 0.64), growth velocity (gram/kilogram/day) (p = 0.104), or an exponential growth velocity outcome (p = 0.423). Conclusion Early antibiotic exposure was not associated with increased growth velocity between birth and discharge. Our study was limited by its retrospective nature and lack of follow-up data postdischarge.

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Section: Discussionmentioning

confidence: 99%

Relationship between Early Antibiotic Exposure and Short-Term Growth Velocity in Premature Neonates

et al. 2018

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“…Highly acclaimed antibiotic stewardship program recommended by CDC emphasizes on judicious use of empirical antibiotics for treating neonatal infections based on local bacteriological profile and sensitivity (9,10) . Formulating Neonatal Intensive Care Unit (NICU) antibiotic policy on a timely basis is the need of the hour (5,11) .…”

Section: Introductionmentioning

confidence: 99%

Bacteriological Analysis of Neonatal Sepsis in a Referral Hospital

D¹

2018

jmscr

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Introduction: Neonatal sepsis is one of the leading causes of mortality and significant morbidity among neonates globally. Formulating Neonatal Intensive Care Unit (NICU) antibiotic policy on a timely basis is the need of hour. This study is aimed at identifying the primary pathogens associated with neonatal sepsis and establishing antibiotic policy based on bacteriological profile and their antibiotic sensitivity. Methods: This is a retrospective study done in a tertiary care referral hospital in South India. The study period was from Sept'17 to Feb'18. The Inclusion criteria were to include all blood culture positive samples of neonates admitted in NICU. Results: There were totally 264 positive cultures during the study period. The gram negative flora predominates with 69.7%. Of the gram negative growth klebsiella was the most common pathogen and proteus was the least common pathogen. There was 30.3% of gram positive growth with CONS as predominant pathogen. Other gram positive bacteria were Enterococcus and staphylococcus. On analysis of the antibiotic sensitivity pattern, more than 50% of klebsiella growths were sensitive to amikacin, ciprofloxacin, cefoperazone and piperacillin. The gram negative isolates were resistant to ampicillin, ceftriaxone, cefotaxime and imipenem. The gram positive isolates were more sensitive to ciprofloxacin, linezolid, piperacillin and cefoperazone. The gram positive isolates of CONS and staphylococcus were less sensitive to vancomycin. Conclusion:The present study reinforces the wide diversity of bacterial isolates in neonatal sepsis and reiterates the need for periodic surveillance of microbial flora. The growing resistance to the antibiotics like vancomycin is of serious concern.

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Restriction of Antimicrobial Usage in a Tertiary Care Neonatal Unit in South India: A Before After Trial

S V N S,

Venugopalan

2020

IJNE

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Background Overuse and abuse of antibiotics resulted in emergence of multidrug-resistant organisms (MDRO), increased rates of invasive candidiasis, prolonged hospital stay, NEC (Necrotizing enterocolitis), LOS (Late onset sepsis) or death. Restriction of the prescription, switching to a narrower spectrum and stopping antibiotics when not needed are some of the major approaches to antibiotic stewardship. Methods We identified restricted antimicrobials and devised an antimicrobial justification form. Clinicians needed to fill the form before prescribing restricted antimicrobials thereby comparing the antimicrobial usage pattern before and after the introduction of form. Babies enrolled before the introduction of the justification form were labelled as Group 1, and as Group 2 after justification form. The HIC (hospital infection control) staff nurse paid daily visits to NICU to monitor number of babies started on restricted antibiotics and whether the forms were duly filled or not. Any lag would be intimated to the Head HIC team for rectification. Any change of antibiotic within the restricted group also warranted justification. Culture report notified within 48 – 72 hrs so as to facilitate the stoppage of antibiotics in case of negative culture. Results There was a statistically significant reduction in the usage of restricted antimicrobials in the Group B as compared to Group A 150 (40.54%) vs 190 (49.35%) (p = 0.01). There was a statistically significant increase in the % of babies de-escalated from high end antimicrobials in Group B as compared to Group A 90 (60%) vs 56 (29.47%) (p = <0.0001). Duration of restricted antimicrobials reduced from 13.78 ± 2.7 days in Group A to 9.9 ±1.8 days in Group B (p = <0.0001). No difference in the number of babies started on any antibiotic between both the groups (p = 0.1). Conclusion Introduction of the antibiotic justification form as a part of antimicrobial stewardship program resulted in an overall reduced usage of restricted antimicrobials along with rapid de-escalation.

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Antimicrobial Stewardship in the Neonatal Intensive Care Unit (NICU): Building and Sustaining the Effective Collaboration

Cited by 3 publications

References 0 publications

Relationship between Early Antibiotic Exposure and Short-Term Growth Velocity in Premature Neonates

Relationship between Early Antibiotic Exposure and Short-Term Growth Velocity in Premature Neonates

Bacteriological Analysis of Neonatal Sepsis in a Referral Hospital

Restriction of Antimicrobial Usage in a Tertiary Care Neonatal Unit in South India: A Before After Trial

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