A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study.
Antibiotics
Antifungal
Global point prevalence study
Neonatal antimicrobial stewardship
Neonatal infection
Journal
EClinicalMedicine
ISSN: 2589-5370
Titre abrégé: EClinicalMedicine
Pays: England
ID NLM: 101733727
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
25
09
2020
revised:
04
01
2021
accepted:
08
01
2021
entrez:
8
2
2021
pubmed:
9
2
2021
medline:
9
2
2021
Statut:
epublish
Résumé
Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. 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. 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 ( 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. Merck & Co.; The Ohio State University College of Medicine Barnes Medical Student Research Scholarship.
Sections du résumé
BACKGROUND
BACKGROUND
Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts.
METHODS
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
RESULTS
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 (
INTERPRETATION
CONCLUSIONS
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
BACKGROUND
Merck & Co.; The Ohio State University College of Medicine Barnes Medical Student Research Scholarship.
Identifiants
pubmed: 33554094
doi: 10.1016/j.eclinm.2021.100727
pii: S2589-5370(21)00007-9
pmc: PMC7848759
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100727Informations de copyright
© 2021 The Authors.
Déclaration de conflit d'intérêts
Dr. Pablo J. Sánchez has received research grant support from Merck & Co. during the conduct of the study, and grant from MedImmune, Inc - AstraZeneca, outside of the submitted work. Dr. Pavel Prusakov has received research grant support from Merck & Co. and Pfizer. Dr. Debra A. Goff has received research grant support from Merck & Co. and Pfizer. Dr. Landgrave reports other support from GSK, outside the submitted work. Dr. Kekomäki reports grants and personal fees from Sanofi, grants and personal fees from Merck Sharp & Dome, other support from Pfizer, all outside of the submitted work. Dr. Mesa reports speaker fees from Pfizer and GlaxoSmithKline, outside of the submitted work. Mr. Wozniak received a Barnes Medical Student Research Scholarship grant from The Ohio State University College of Medicine. The other authors have nothing to disclose.
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