Antimicrobial stewardship in the NICU

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Pharmacology

Background:

• Neonatal intensive care units (NICUs) present unique antimicrobial stewardship challenges.
• Diagnosing infections in neonates is difficult due to nonspecific signs and symptoms.
• Significant variation exists in the treatment duration for suspected sepsis and pneumonia within and between NICUs.

Purpose of the Study:

• To highlight the challenges of antimicrobial stewardship in NICUs.
• To propose essential components for sustainable antibiotic stewardship programs.
• To outline potential interventions for optimizing antibiotic use in neonates.

Main Methods:

• Review of existing challenges and variations in antimicrobial therapy in NICUs.
• Identification of key elements for successful stewardship programs, including multidisciplinary teams and metrics.
• Discussion of potential interventions such as optimizing culturing, using NICU-specific antibiograms, ancillary tests, and early discontinuation of therapy.

Main Results:

• Nonspecific signs and symptoms complicate neonatal infection diagnosis.
• Variability in treatment duration for suspected infections is a significant issue.
• Multidisciplinary teams and targeted interventions are crucial for effective stewardship.

Conclusions:

• Sustainable antimicrobial stewardship in NICUs requires multidisciplinary collaboration and data-driven strategies.
• Optimizing diagnostic and therapeutic approaches, guided by local data, is essential.
• Leveraging large neonatal databases can facilitate benchmarking and comparative effectiveness research for antibiotic use.