Antibiotic Use in Very Low Birth Weight Neonates After an Antimicrobial Stewardship Program.

Alberto Berardi,Greta Toni,Cecilia Rossi,Laura Lucaccioni,Eugenio Spaggiari,Licia Lugli,Lorenzo Iughetti,Isotta Zinani,Virginia D’Amico,Luca Bedetti

doi:10.3390/antibiotics10040411

Alberto Berardi, Greta Toni + Show 8 more

Open Access

https://doi.org/10.3390/antibiotics10040411

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Journal: Antibiotics	Publication Date: Apr 9, 2021
Citations: 11	License type: CC BY 4.0

Affiliation: University of Modena and Reggio Emilia

Abstract

There is insufficient data regarding antimicrobial stewardship (AS) and outcomes of very low birth weight (VLBW) neonates after AS programs. This observational, retrospective study addressed AS and outcomes of VLBW neonates admitted to an Italian level-three center. Two periods were compared: (i) baseline, before AS (January 2011–December 2012) and (ii) intervention, after AS (January 2016–December 2017). Between these two periods, procedures were put in place to inform medical and nursing staff regarding AS. There were 111 and 119 VLBW neonates in the baseline (6744 live births) and in the intervention period (5902 live births), respectively. The number of infants exposed to antibiotics (70%) during the hospital stay did not change, but the total days of therapy (DOT, median 12 vs. 5) and DOT/1000 patient days (302 vs. 215) decreased in the intervention period (p < 0.01), as well as the median duration of first antibiotic treatment (144 vs. 48 h, p < 0.01). A re-analysis of single cases of culture-proven or culture-negative sepsis failed to demonstrate any association between deaths and a delay or insufficient antibiotic use in the intervention period. In conclusion, AS is feasible in preterm VLBW neonates and antibiotic use can be safely reduced.

Highlights

Neonatal sepsis is a serious and potentially fatal illness; early diagnosis and prompt treatment is essential to prevent life threatening complications
Prolonged early empiric antibiotic administration in preterm neonates has been associated with an increased risk of necrotizing enterocolitis (NEC) [7], late onset sepsis (LOS) and death, as well as the risk of invasive fungal infections [8], or selecting multidrug-resistant pathogens [9,10]
A few neonates were excluded from the study because of missing data on antibiotic treatments: eight neonates in the baseline and two neonates in the intervention period

Summary

Introduction

Neonatal sepsis is a serious and potentially fatal illness; early diagnosis and prompt treatment is essential to prevent life threatening complications. Antibiotics play a pivotal role in the treatment of neonatal infections and are the most commonly used drugs in the neonatal intensive care unit (NICU) [1]. Both early onset sepsis (EOS) and late onset sepsis (LOS), which present prior to or after 72 h of life, respectively, are much more frequent in preterm neonates with very low birth weight (VLBW) compared to full term neonates, and the risk of infectious mortality is exceedingly high. Prolonged early empiric antibiotic administration in preterm neonates has been associated with an increased risk of necrotizing enterocolitis (NEC) [7], LOS and death, as well as the risk of invasive fungal infections [8], or selecting multidrug-resistant pathogens [9,10]. Antibiotic exposure increases the risks of acute drug toxicities, the costs, and potential unintended consequences of escalated monitoring [11,12]

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