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

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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

Original languageEnglish
Article number100727
Publication statusPublished - 2021


  • 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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