Antibiotic stewardship works in NICUs, more evidence shows
Click Here to Manage Email Alerts
Key takeaways:
- Excessive antimicrobial use has been linked to increased neonatal mortality.
- Antimicrobial stewardship is linked to reduced antimicrobial use in NICUs without an increase in adverse events.
Findings from a literature review published in Pediatrics provided more evidence that antimicrobial stewardship reduces antimicrobial use in NICUs without an increase in adverse events.
According to the authors of the review, neonatal sepsis is a major contributor to morbidity and mortality, with antimicrobials being the most frequent treatment.
However, “Excessive use of antimicrobials has been linked to increased neonatal mortality, morbidity, adverse developmental outcome and antibiotic resistance,” Prakash S. Shah, MSc, professor of pediatrics at the University of Toronto, told Healio. “Antimicrobial stewardship programs (ASPs) in neonates have been evaluated in the past. However, they have only been noted in a small number of studies.”
“We all have attempted to reduce antimicrobial exposure and units. However, we know that this is a balancing act,” Dwayne D. Mascarenhas, MD, DM, a clinical fellow in neonatology at the University of Toronto, said in the video.
The objective of the study was to systematically review the effectiveness, balancing measures and sustainability of ASP interventions in neonates, Mascarenhas said. As part of their literature review, the researchers pulled studies from PubMed, Medline, Embase, Cochrane CENTRAL, Web of Science and SCOPUS, with a cutoff date of May 22, 2023.
Out of 4,048 studies retrieved, the researchers included 70 studies in their review: 44 cohort studies and 26 observational studies encompassing 358,317 neonates who met the inclusion criteria.
According to the researchers, moderate-certainty evidence revealed a significant reduction in the rate of antimicrobial use in NICUs after the implementation of an ASP from around 78% to less than 54%, with a pooled risk difference (RD) of 19% (95% CI, 14%-24%) in 21 studies that included 27,075 infants.
The review also identified reductions in antimicrobial use after ASP initiation in combined NICU and postnatal ward settings (pooled RD = 8%; 95% CI, 6%-10%; 12 studies, 358,317 infants).
ASPs were also associated with a reduction in the duration of therapy (pooled RD = 20%; 95% CI, 10%-30%; nine studies, 303,604 infants), length of therapy (pooled RD = 1.82 days; 95% CI, 1.09-2.56 days; 10 studies, 157,553 infants), and use of antimicrobial agents for more than 5 days (pooled RD = 9%; 95% CI, 3%-15%; five studies, 9,412 infants).
Moreover, “There was no increase in adverse outcomes ... such as sepsis-related deaths or initiation of antimicrobial agents,” Mascarenhas said. “Moderate-low certainty evidence suggests that ASP interventions in neonates are associated with either limiting initiation or curtailing duration of antimicrobial exposure, both in NICU and postnatal settings without increasing adverse events.”
In a related editorial, Joseph B. Cantey, MD, MPH, a neonatologist at the University of Texas Health San Antonio, discussed the “explosion of neonatal ASPs in the past 15 years.”
“Stewardship in the NICU setting has gone from an idea to an evidence-based practice. Abundant evidence, beautifully reviewed by [Mascarenhas] et al, supports that neonatal ASPs can reduce unnecessary antibiotic consumption,” Cantey wrote. “Now, attention must turn to the next frontier — showing that effective neonatal antimicrobial stewardship will improve meaningful, patient-level outcomes. Less sepsis. Less [necrotizing enterocolitis]. Less death. Better, healthier lives for our smallest patients.”
Cantey praised the researchers for an “excellent review” and joined their call for “a uniform and expanded approach to reporting these important outcomes.”
“Neonatal antimicrobial stewardship programs were conceptualized on a premise that preventing unnecessary or prolonged antibiotic exposure would also prevent adverse outcomes,” Cantey wrote. “The time has come to deliver on the promise of that premise.”
References:
- Cantey JB, et al. Pediatrics. 2024;doi:10.1542/peds.2024-065735.
- Mascarenhas D, et al. Pediatrics. 2024;doi:10.1542/peds.2023-065091.
Collapse
Read more about
Click Here to Manage Email Alerts