Standardizing the approach to late onset sepsis in neonates through antimicrobial stewardship: a quality improvement initiative

Lamba, Vineet; D'Souza, Sunitha; Carafa, C; Zepf, A; Bassel, C L; Gutierrez, Mariana; Balakrishnan, Maya

doi:10.1038/s41372-019-0577-5

Cited by 14 publications

(12 citation statements)

References 24 publications

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“…Performance of full sepsis evaluations (e.g. blood, urine, cerebrospinal fluid) before initiation of antibiotic therapy, obtaining sufficient quantity of blood for culture, and investigation of viral and fungal etiologies should allow comfort in discontinuation of antibiotics if cultures are sterile [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] . Ultimately, genomic methods for detection of microbial pathogens in body fluids may allow optimal identification of infected infants and more appropriate use of antimicrobial therapy [ 59 , 60 ].…”

Section: Discussionmentioning

confidence: 99%

A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study

et al. 2021

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Background Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. Methods We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. Findings On July 1, 2019, 26% of infants (580/2,265; range, 0–100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received ≥1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were “rule-out” sepsis (32%) and “culture-negative” sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and “culture-negative” infections was 12 days (median; IQR, 8–14) and 7 days (median; IQR, 5–10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization ( p = 0·02). Interpretation Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide. Funding Merck & Co.; The Ohio State University College of Medicine Barnes Medical Student Research Scholarship

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Section: Discussionmentioning

confidence: 99%

A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study

et al. 2021

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“…Finally, 19 studies were included in this systematic review and meta-analysis (Figure 1). [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]…”

Section: Literature Search Resultsmentioning

confidence: 99%

“…and 79 neonates died in the pre-and post-ASP periods, respectively, and the difference was not significant (odds ratio [OR]: 0.83, 95% CI: 0.53-1.32, p = 0.44; Figure 4). Seven studies reported LOS in the pre-and post-ASP periods [19][20][21]26,27,34,37 ; of these, three 21,34,37 were included in the meta-analysis. The effect of the implementation of ASP for LOS was not significant (weighted mean difference: 0.04 days, 95% CI: −1.11 to 1.19, p = 0.94; Figure 5).…”

Section: Results Of Asp Implementation In Terms Of Clinical and Econo...mentioning

confidence: 99%

“…Inappropriate antibiotic use was reported in four studies 26,31,35,36 : redundant antibiotic use, unnecessary antibiotic dosing, inappropriate prescription, and inappropriate indication or duration of antibiotic therapy. ASP implementation resulted in decreased redundant antibiotic use, unnecessary antibiotic dosing, and inappropriate prescription or duration of antibiotic therapy by 72.7%, 85.6%, and 48.4%‐62.6%, respectively, compared to those in the pre‐ASP period.…”

Section: Resultsmentioning

confidence: 99%

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Impact of pharmacist intervention in antibiotic stewardship programmes for critically ill neonates: A systematic review and meta‐analysis

Lee

2021

Clinical Pharmacy Therapeu

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What is known and objective Antibiotic stewardship programmes (ASPs) are introduced to ensure effective antibiotic use. Pharmacists can be involved in ASPs to facilitate the appropriate antibiotic use. Prolonged use of antibiotics causes adverse events in critically ill neonates. Hence, this systematic review and meta‐analysis was aimed at investigating pharmacists’ functions in ASPs in critically ill neonates and the effect of ASP implementation on antibiotic use. Methods A comprehensive search of PubMed/Medline, Embase, and Cochrane Library databases until January 2021 was conducted and studies that reported the functions of pharmacists in ASPs for critically ill neonates and the results of ASP implementation were included in this review. All processes were performed by two reviewers independently, and any discordance between the two was resolved by discussion. Results and discussion In all, 19 studies were included in this review. Pharmacists were found to have various functions in ASPs, such as participating in the development of antibiotic use guidelines, auditing antibiotic prescriptions, participating in multidisciplinary ward rounds, educating other ASP team members, checking blood culture or laboratory data, and monitoring antibiotic use. A meta‐analysis revealed that ASP implementation in critically ill neonates was significantly associated with a 23% reduction in the overall antibiotic use rate (ratio of means: 0.77, 95% confidence interval: 0.69–0.87, p < 0.001). Moreover, the overall duration of antibiotic therapy significantly reduced by 15% with ASP implementation (ratio of means: 0.85, 95% confidence interval: 0.78–0.91, p < 0.001). What is new and conclusion The implementation of ASPs involving pharmacists, especially in critically ill neonates, was associated with the reduced use and duration of antibiotic treatment. Thus, pharmacists played a key role in ASPs in critically ill neonates.

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“…They achieved ≥75% compliance, after interventions. The authors identified Key elements for successful implementation: (1) team composition, (2) meeting huddle efficiency, and (3) providing actionable feedback and education on identified opportunities following best practices for QI ( 16 ).…”

Section: Improving Performance Through Quality Improvement Toolsmentioning

confidence: 99%

Barriers and Proposed Solutions to a Successful Implementation of Pediatric Sepsis Protocols

et al. 2021

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The implementation of managed protocols contributes to a systematized approach to the patient and continuous evaluation of results, focusing on improving clinical practice, early diagnosis, treatment, and outcomes. Advantages to the adoption of a pediatric sepsis recognition and treatment protocol include: a reduction in time to start fluid and antibiotic administration, decreased kidney dysfunction and organ dysfunction, reduction in length of stay, and even a decrease on mortality. Barriers are: absence of a written protocol, parental knowledge, early diagnosis by healthcare professionals, venous access, availability of antimicrobials and vasoactive drugs, conditions of work, engagement of healthcare professionals. There are challenges in low-middle-income countries (LMIC). The causes of sepsis and resources differ from high-income countries. Viral agent such as dengue, malaria are common in LMIC and initial approach differ from bacterial infections. Some authors found increased or no impact in mortality or increased length of stay associated with the implementation of the SCC sepsis bundle which reinforces the importance of adapting it to most frequent diseases, disposable resources, and characteristics of healthcare professionals. Conclusions: (1) be simple; (2) be precise; (3) education; (5) improve communication; (5) work as a team; (6) share and celebrate results.

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Standardizing the approach to late onset sepsis in neonates through antimicrobial stewardship: a quality improvement initiative

Cited by 14 publications

References 24 publications

A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study

A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study

Impact of pharmacist intervention in antibiotic stewardship programmes for critically ill neonates: A systematic review and meta‐analysis

Barriers and Proposed Solutions to a Successful Implementation of Pediatric Sepsis Protocols

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