Antimicrobial Stewardship for Newborns in the Neonatal Intensive Care Unit

2017 ◽  
Vol 12 (03) ◽  
pp. 171-175
Author(s):  
B. English ◽  
Rebecca Schein
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Antimicrobial Stewardship ◽  
Neonatal Intensive Care ◽  
Treatment Guidelines ◽  
Late Onset ◽  
Appropriate Use ◽  
Late Onset Sepsis ◽  
Treatment Data

AbstractOveruse of antibiotics causing antibiotic resistance, an increase in Clostridium difficile infections, and increased adverse drug reactions is a growing problem. To combat this growing threat, the Centers for Disease Control started a program to improve the appropriate use of antimicrobials that focuses on antimicrobial stewardship. In the neonatal intensive care unit (NICU) medically fragile infants are commonly exposed to antibiotics resulting in a growing interest in applying antimicrobial stewardship principles in this patient population. The lack of treatment guidelines and the relatively narrow spectrum of individual antibiotics used to make the NICU a unique environment requiring a specialized approach to antimicrobial stewardship. This article examines the current antibiotic treatment data for common NICU illnesses including early and late-onset sepsis, pneumonia, and necrotizing enterocolitis, then reviews current recommendations for antimicrobial stewardship.

scholarly journals Underlying Characteristics and Outcome of Extensively Resistant Acinetobacter baumannii Infection and Colonization in a Saudi Neonatal Intensive Care Unit

2019 ◽  
Vol 09 (01) ◽  
pp. e93-e99 ◽  
Author(s):  
Sarah Alsubaie ◽  
Zahid Anwar ◽  
Mohamed Alhadidi ◽  
Boshra Alsaadi ◽  
Muslim Alsaadi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Acinetobacter Baumannii ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Resistance Rate ◽  
The Body ◽  
Late Onset Sepsis

AbstractExtensively drug-resistant Acinetobacter baumannii (XDRAB) is a rapidly emerging pathogen causing threat to health care settings. The resultant morbidity and mortality rates are high due to limited therapeutic options. The present study demonstrates the characteristics of neonates, infected or colonized with XDRAB, antibiotic susceptibility patterns of the isolates, and neonatal outcomes. This retrospective study was conducted in the neonatal intensive care unit (NICU) of Dallah hospital, Riyadh, Saudi Arabia during the period January 2015 to December 2017. All neonates with positive XDRAB cultures from any location in the body were included, infected and colonized cases were compared. XDRAB was isolated from 16 neonates. Seventy-five percent of the affected neonates were preterm, with a median gestational age and birth weight of 32.5 weeks and 1,675 g, respectively. The median time to XDRAB infection/colonization for all cases was 14 days. Seventy-five percent of the cases had central venous catheters and 50 percent had surgery/procedure performed during stay in NICU. Half of the affected neonates had underlying congenital anomalies and chronic medical conditions. Fourteen affected neonates (87%) received prior courses of cefotaxime. In 15 of 16 cases, XDRAB infection manifested clinically as late-onset sepsis with bacteremia and ventilator-associated pneumonia (VAP). XDRAB isolates were resistant to all β-lactams and carbapenems. Resistance rate to other antibiotics was 93% for gentamicin and 50% for ciprofloxacin. All XDRAB isolates were susceptible to colistin. Seventy-five percent of the infected neonates died due to XDRAB sepsis, while 37% of the colonized group died of other underlying diseases. Fifty percent of the infected neonates died within 4 days of XDRAB infection. Prematurity, low birth weight, the use of vascular devices, and prior use of cefotaxime played a major role in XDRAB infection/colonization in our unit. It is crucial to consider early start of colistin, either alone or in combination therapy, especially for the neonates at high risk, for example, those with certain underlying chronic conditions who manifest with late-onset sepsis and/or VAP.

Implementation of an Antimicrobial Stewardship Program in a Neonatal Intensive Care Unit

2017 ◽  
Vol 38 (10) ◽  
pp. 1137-1143 ◽  
Author(s):  
Nneka I. Nzegwu ◽  
Michelle R. Rychalsky ◽  
Loren A. Nallu ◽  
Xuemei Song ◽  
Yanhong Deng ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Time Series ◽  
Intensive Care ◽  
Antimicrobial Stewardship ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Interrupted Time Series ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Late Onset Sepsis

OBJECTIVETo evaluate antimicrobial utilization and prescription practices in a neonatal intensive care unit (NICU) after implementation of an antimicrobial stewardship program (ASP).DESIGNQuasi-experimental, interrupted time-series study.SETTINGA 54-bed, level IV NICU in a regional academic and tertiary referral center.PATIENTS AND PARTICIPANTSAll neonates prescribed antimicrobials from January 1, 2011, to June 30, 2016, were eligible for inclusion.INTERVENTIONImplementation of a NICU-specific ASP beginning July 2012.METHODSWe convened a multidisciplinary team and developed guidelines for common infections, with a focus on prescriber audit and feedback. We conducted an interrupted time-series analysis to evaluate the effects of our ASP. Our primary outcome measure was days of antibiotic therapy (DOT) per 1,000 patient days for all and for select antimicrobials. Secondary outcomes included provider-specific antimicrobial prescription events for suspected late-onset sepsis (blood or cerebrospinal fluid infection at >72 hours of life) and guideline compliance.RESULTSAntibiotic utilization decreased by 14.7 DOT per 1,000 patient days during the stewardship period, although this decrease was not statistically significant (P=.669). Use of ampicillin, the most commonly antimicrobial prescribed in our NICU, decreased significantly, declining by 22.5 DOT per 1,000 patient days (P=.037). Late-onset sepsis evaluation and prescription events per 100 NICU days of clinical service decreased significantly (P<.0001), with an average reduction of 2.65 evaluations per year per provider. Clinical guidelines were adhered to 98.75% of the time.CONCLUSIONSImplementation of a NICU-specific antimicrobial stewardship program is feasible and can improve antibiotic prescribing practices.Infect Control Hosp Epidemiol 2017;38:1137–1143

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