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

for the Global NEO-ASP Study Group; P. Prusakov; D.A. Goff; P.S. Wozniak; A. Cassim; C.E.A. Scipion; S. Urzúa; A. Ronchi; L. Zeng; O. Ladipo-Ajayi; N. Aviles-Otero; C.R. Udeigwe-Okeke; R. Melamed; R.C. Silveira; C. Auriti; C. Beltrán-Arroyave; E. Zamora-Flores; M. Sanchez-Codez; E.S. Donkor; S. Kekomäki; N. Mainini; R.V. Trochez; J. Casey; J.M. Graus; M. Muller; S. Singh; Y. Loeffen; M.E.T. Pérez; G.I. Ferreyra; V. Lima-Rogel; B. Perrone; G. Izquierdo; M. Cernada; S. Stoffella; S.O. Ekenze; C. de Alba-Romero; C. Tzialla; J.T. Pham; K. Hosoi; M.C.C. Consuegra; P. Betta; O.A. Hoyos; E. Roilides; G. Naranjo-Zuñiga; M. Oshiro; V. Garay; V. Mondì; D. Mazzeo; J.A. Stahl; F. Piersigilli; A. Porta

doi:10.1016/j.eclinm.2021.100727

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

for the Global NEO-ASP Study Group, P. Prusakov, D.A. Goff, P.S. Wozniak, A. Cassim, C.E.A. Scipion, S. Urzúa, A. Ronchi, L. Zeng, O. Ladipo-Ajayi, N. Aviles-Otero, C.R. Udeigwe-Okeke, R. Melamed, R.C. Silveira, C. Auriti, C. Beltrán-Arroyave, E. Zamora-Flores, M. Sanchez-Codez, E.S. Donkor, S. KekomäkiN. Mainini, R.V. Trochez, J. Casey, J.M. Graus, M. Muller, S. Singh, Y. Loeffen, M.E.T. Pérez, G.I. Ferreyra, V. Lima-Rogel, B. Perrone, G. Izquierdo, M. Cernada, S. Stoffella, S.O. Ekenze, C. de Alba-Romero, C. Tzialla, J.T. Pham, K. Hosoi, M.C.C. Consuegra, P. Betta, O.A. Hoyos, E. Roilides, G. Naranjo-Zuñiga, M. Oshiro, V. Garay, V. Mondì, D. Mazzeo, J.A. Stahl, F. Piersigilli, A. Porta

Research output: Contribution to journal › Article › peer-review

Abstract

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

Original language	English
Article number	100727
Journal	EClinicalMedicine
Volume	32
DOIs	https://doi.org/10.1016/j.eclinm.2021.100727
Publication status	Published - 2021

Keywords

Antibiotics
Antifungal
Global point prevalence study
Neonatal antimicrobial stewardship
Neonatal infection
amikacin
amoxicillin
amoxicillin plus clavulanic acid
ampicillin
antacid agent
antibiotic agent
antifungal agent
antiinfective agent
antivirus agent
azithromycin
aztreonam
bacitracin
cefepime
ceftriaxone
cefuroxime
cephalosporin derivative
ciprofloxacin
clarithromycin
erythromycin
gentamicin
imipenem
isoniazid
levofloxacin
linezolid
meropenem
piperacillin
piperacillin plus tazobactam
probiotic agent
pseudomonic acid
rifampicin
teicoplanin
tobramycin
vancomycin
age
antimicrobial stewardship
antimicrobial therapy
Article
bacterial infection
bacterium culture
birth weight
clinical feature
controlled study
correlation analysis
cross-sectional study
demography
drug indication
female
gestational age
high income country
hospital mortality
human
infant
infectious agent
low income country
major clinical study
male
microbiological examination
middle income country
mortality
mycosis
neonatal intensive care unit
nonhuman
observational study
point prevalence
sepsis
treatment duration
virus infection

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10.1016/j.eclinm.2021.100727

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for the Global NEO-ASP Study Group, Prusakov, P., Goff, D. A., Wozniak, P. S., Cassim, A., Scipion, C. E. A., Urzúa, S., Ronchi, A., Zeng, L., Ladipo-Ajayi, O., Aviles-Otero, N., Udeigwe-Okeke, C. R., Melamed, R., Silveira, R. C., Auriti, C., Beltrán-Arroyave, C., Zamora-Flores, E., Sanchez-Codez, M., Donkor, E. S., ... Porta, A. (2021). A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study. EClinicalMedicine, 32, [100727]. https://doi.org/10.1016/j.eclinm.2021.100727

for the Global NEO-ASP Study Group, Prusakov, P, Goff, DA, Wozniak, PS, Cassim, A, Scipion, CEA, Urzúa, S, Ronchi, A, Zeng, L, Ladipo-Ajayi, O, Aviles-Otero, N, Udeigwe-Okeke, CR, Melamed, R, Silveira, RC, Auriti, C, Beltrán-Arroyave, C, Zamora-Flores, E, Sanchez-Codez, M, Donkor, ES, Kekomäki, S, Mainini, N, Trochez, RV, Casey, J, Graus, JM, Muller, M, Singh, S, Loeffen, Y, Pérez, MET, Ferreyra, GI, Lima-Rogel, V, Perrone, B, Izquierdo, G, Cernada, M, Stoffella, S, Ekenze, SO, de Alba-Romero, C, Tzialla, C, Pham, JT, Hosoi, K, Consuegra, MCC, Betta, P, Hoyos, OA, Roilides, E, Naranjo-Zuñiga, G, Oshiro, M, Garay, V, Mondì, V, Mazzeo, D, Stahl, JA, Piersigilli, F & Porta, A 2021, 'A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study', EClinicalMedicine, vol. 32, 100727. https://doi.org/10.1016/j.eclinm.2021.100727

@article{0d3feed3568e4636b450889da61c150e,

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

abstract = "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",

keywords = "Antibiotics, Antifungal, Global point prevalence study, Neonatal antimicrobial stewardship, Neonatal infection, amikacin, amoxicillin, amoxicillin plus clavulanic acid, ampicillin, antacid agent, antibiotic agent, antifungal agent, antiinfective agent, antivirus agent, azithromycin, aztreonam, bacitracin, cefepime, ceftriaxone, cefuroxime, cephalosporin derivative, ciprofloxacin, clarithromycin, erythromycin, gentamicin, imipenem, isoniazid, levofloxacin, linezolid, meropenem, piperacillin, piperacillin plus tazobactam, probiotic agent, pseudomonic acid, rifampicin, teicoplanin, tobramycin, vancomycin, age, antimicrobial stewardship, antimicrobial therapy, Article, bacterial infection, bacterium culture, birth weight, clinical feature, controlled study, correlation analysis, cross-sectional study, demography, drug indication, female, gestational age, high income country, hospital mortality, human, infant, infectious agent, low income country, major clinical study, male, microbiological examination, middle income country, mortality, mycosis, neonatal intensive care unit, nonhuman, observational study, point prevalence, sepsis, treatment duration, virus infection",

author = "{for the Global NEO-ASP Study Group} and P. Prusakov and D.A. Goff and P.S. Wozniak and A. Cassim and C.E.A. Scipion and S. Urz{\'u}a and A. Ronchi and L. Zeng and O. Ladipo-Ajayi and N. Aviles-Otero and C.R. Udeigwe-Okeke and R. Melamed and R.C. Silveira and C. Auriti and C. Beltr{\'a}n-Arroyave and E. Zamora-Flores and M. Sanchez-Codez and E.S. Donkor and S. Kekom{\"a}ki and N. Mainini and R.V. Trochez and J. Casey and J.M. Graus and M. Muller and S. Singh and Y. Loeffen and M.E.T. P{\'e}rez and G.I. Ferreyra and V. Lima-Rogel and B. Perrone and G. Izquierdo and M. Cernada and S. Stoffella and S.O. Ekenze and {de Alba-Romero}, C. and C. Tzialla and J.T. Pham and K. Hosoi and M.C.C. Consuegra and P. Betta and O.A. Hoyos and E. Roilides and G. Naranjo-Zu{\~n}iga and M. Oshiro and V. Garay and V. Mond{\`i} and D. Mazzeo and J.A. Stahl and F. Piersigilli and A. Porta",

note = "Export Date: 17 August 2021",

year = "2021",

doi = "10.1016/j.eclinm.2021.100727",

language = "English",

volume = "32",

journal = "EClinicalMedicine",

issn = "2589-5370",

}

TY - JOUR

T1 - A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study

AU - for the Global NEO-ASP Study Group

AU - Prusakov, P.

AU - Goff, D.A.

AU - Wozniak, P.S.

AU - Cassim, A.

AU - Scipion, C.E.A.

AU - Urzúa, S.

AU - Ronchi, A.

AU - Zeng, L.

AU - Ladipo-Ajayi, O.

AU - Aviles-Otero, N.

AU - Udeigwe-Okeke, C.R.

AU - Melamed, R.

AU - Silveira, R.C.

AU - Auriti, C.

AU - Beltrán-Arroyave, C.

AU - Zamora-Flores, E.

AU - Sanchez-Codez, M.

AU - Donkor, E.S.

AU - Kekomäki, S.

AU - Mainini, N.

AU - Trochez, R.V.

AU - Casey, J.

AU - Graus, J.M.

AU - Muller, M.

AU - Singh, S.

AU - Loeffen, Y.

AU - Pérez, M.E.T.

AU - Ferreyra, G.I.

AU - Lima-Rogel, V.

AU - Perrone, B.

AU - Izquierdo, G.

AU - Cernada, M.

AU - Stoffella, S.

AU - Ekenze, S.O.

AU - de Alba-Romero, C.

AU - Tzialla, C.

AU - Pham, J.T.

AU - Hosoi, K.

AU - Consuegra, M.C.C.

AU - Betta, P.

AU - Hoyos, O.A.

AU - Roilides, E.

AU - Naranjo-Zuñiga, G.

AU - Oshiro, M.

AU - Garay, V.

AU - Mondì, V.

AU - Mazzeo, D.

AU - Stahl, J.A.

AU - Piersigilli, F.

AU - Porta, A.

N1 - Export Date: 17 August 2021

PY - 2021

Y1 - 2021

N2 - 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

AB - 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

KW - Antibiotics

KW - Antifungal

KW - Global point prevalence study

KW - Neonatal antimicrobial stewardship

KW - Neonatal infection

KW - amikacin

KW - amoxicillin

KW - amoxicillin plus clavulanic acid

KW - ampicillin

KW - antacid agent

KW - antibiotic agent

KW - antifungal agent

KW - antiinfective agent

KW - antivirus agent

KW - azithromycin

KW - aztreonam

KW - bacitracin

KW - cefepime

KW - ceftriaxone

KW - cefuroxime

KW - cephalosporin derivative

KW - ciprofloxacin

KW - clarithromycin

KW - erythromycin

KW - gentamicin

KW - imipenem

KW - isoniazid

KW - levofloxacin

KW - linezolid

KW - meropenem

KW - piperacillin

KW - piperacillin plus tazobactam

KW - probiotic agent

KW - pseudomonic acid

KW - rifampicin

KW - teicoplanin

KW - tobramycin

KW - vancomycin

KW - age

KW - antimicrobial stewardship

KW - antimicrobial therapy

KW - Article

KW - bacterial infection

KW - bacterium culture

KW - birth weight

KW - clinical feature

KW - controlled study

KW - correlation analysis

KW - cross-sectional study

KW - demography

KW - drug indication

KW - female

KW - gestational age

KW - high income country

KW - hospital mortality

KW - human

KW - infant

KW - infectious agent

KW - low income country

KW - major clinical study

KW - male

KW - microbiological examination

KW - middle income country

KW - mortality

KW - mycosis

KW - neonatal intensive care unit

KW - nonhuman

KW - observational study

KW - point prevalence

KW - sepsis

KW - treatment duration

KW - virus infection

U2 - 10.1016/j.eclinm.2021.100727

DO - 10.1016/j.eclinm.2021.100727

M3 - Article

VL - 32

JO - EClinicalMedicine

JF - EClinicalMedicine

SN - 2589-5370

M1 - 100727

ER -

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

Abstract

Keywords

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