Reduced antibiotic use in extremely preterm infants with an antimicrobial stewardship intervention

Abstract

IntroductionExcessive administration of antibiotics to preterm infants is associated with increased rates of complications. The purpose of the study was to evaluate the effect of an antimicrobial stewardship intervention on antibiotic use in extremely preterm infants.Design, setting, patients and interventionA before and after study of infants born at ≤28 weeks’ gestational age was performed in the neonatal intensive care unit of Queen Silvia’s Children’s Hospital, Gothenburg, Sweden. Retrospective analysis of the baseline period (January–December 2014) guided the development of a limited antimicrobial stewardship intervention. The intervention consisted of updated local guidelines with a focus on shortened and standardised treatment duration plus increased access to infectious disease consultant advice. It was fully implemented during the intervention period (October 2017–September 2018).ObjectivePrimary aim was to compare antibiotic use, defined as antibiotic treatment days per 1000 patient-days, between the two periods, and the secondary aim was to evaluate the number of days with meropenem-based regimens before and after the intervention.ResultsWe included 145 infants with a median birth weight of 870 g and median gestational age of 26 weeks. The baseline period comprised 82 infants and 3478 patient-days, the intervention period comprised 63 infants and 2753 patient-days. Overall antibiotic use (treatment and prophylaxis) was 534 versus 466 days per 1000 patient-days during the baseline and intervention periods, respectively. Antibiotic treatment days decreased from 287 to 197 days per 1000 patient-days. The proportion of meropenem-based regimens was 69% versus 44%, respectively. No increases in mortality or reinitiation of antibiotics were seen.ConclusionsImplementation of a limited antimicrobial stewardship intervention anchored in analysis of previous prescription patterns can contribute to safe decreases in antibiotic use in extremely preterm infants.

Errors in Antimicrobial Prescription and Administration in Very Low Birth Weight Neonates at a Tertiary South African Hospital

“…In a systematic review of optimal antibiotic duration in children, 10 days of intravenous treatment is suggested for bacteraemia caused by gram negative organisms and 7-14 days for Staphylococcal infections (38). In many neonatal units there is substantial variability in duration of antimicrobial therapy for infection, and this is a potential target for antimicrobial stewardship to standardize, and where safe to do so, reduce length of therapy (39). The potential for adverse drug events in neonates is high, especially for patients in the NICU, with 79% occurring at the stage of drug prescribing and 34% involving incorrect dosing in one American study (40).…”

Reducing Duration of Antibiotic Use for Presumed Neonatal Early-Onset Sepsis in Greek NICUs. A “Low-Hanging Fruit” Approach

“…A variety of known stewardship methodologies have been used in previous efforts to promote judicious antimicrobial use in NICUs. Revision or introduction of guidelines, prospective audit and feedback, pre-authorization, automatic stop orders and multidisciplinary rounds [11,[17][18][19][20][21][22][23][24][25][26], have all been successful in lowering consumption according to the researchers' targets. Nonetheless, in some cases, stewardship interventions do not lead to shorter duration of therapy, even if additional diagnostics are used [27].…”

Alternative nutritional and clinical care practices for NEC prevention drive distinct profiles and functional responses in the preterm gut microbiome

“…A number of publications have emphasized the need for responsible antibiotic usage in such vulnerable patients, as their use is associated with the risk of infection with multi-drug resistant (MDR) pathogens such as Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae (van Duin and Paterson, 2016) and is believed to have other, largely unknown, long-term effects. Overall, antibiotic exposure is often considered as preventable (Bizzarro, 2018;Gustavsson et al, 2020).…”