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 |
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Article number | 100727 |
Journal | EClinicalMedicine |
Volume | 32 |
DOIs | |
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