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Antibiotics Prescriptions in the Neonatal Intensive Care Unit: How to Overcome Everyday Challenges
D Donà1, E Mozzo1, V Mardegan2
1Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy.
Abstract:
Antimicrobial prescriptions in neonatal intensive care units (NICUs) represent a point of concern for the emergence of MDROs and for morbidity associated with prolonged antibiotic exposure (e.g., invasive candidiasis, necrotizing enterocolitis, and late-onset sepsis). Antimicrobial stewardship programs (ASPs) have shown to be a valuable tool for the prevention of resistance with the goals of optimizing clinical outcomes while decreasing unnecessary prescribing. The most frequent ASP strategies include the correct collection and interpretation of microbiological specimens, prescription of the narrowest-spectrum antibiotic appropriate for a particular case, and de-escalation or discontinuation of therapy in defined situations. A robust ASP requires everyday multidisciplinary collaboration between ID physicians, neonatologist, clinical pharmacists, clinical microbiologists, infection control professionals, hospital epidemiologists, and information services specialists. Education and clinical pathways (e.g., sepsis or surgical prophylaxis pathways) are an excellent starting point if followed by proactive interventions such as prospective audits and feedback and formulary restriction with prior antimicrobial authorization. The current review outlines the problems faced in NICU antimicrobial prescribing and presents various solutions from the literature.
Insights
Antimicrobial stewardship programs (ASPs) in neonatal intensive care units (NICUs) are crucial for preventing multidrug-resistant organisms (MDROs) and reducing antibiotic-related harm. Effective ASPs involve multidisciplinary collaboration and specific strategies to optimize antibiotic use.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Antimicrobial use in neonatal intensive care units (NICUs) contributes to multidrug-resistant organisms (MDROs) and patient morbidity.
- Prolonged antibiotic exposure in neonates is linked to adverse outcomes like invasive candidiasis, necrotizing enterocolitis, and late-onset sepsis.
Purpose of the Study:
- To review challenges in antimicrobial prescribing within NICUs.
- To present evidence-based solutions and strategies for antimicrobial stewardship programs (ASPs).
Main Methods:
- Literature review of antimicrobial stewardship strategies in NICU settings.
- Discussion of multidisciplinary collaboration essential for robust ASPs.
- Highlighting key ASP interventions such as specimen management, narrow-spectrum prescribing, and de-escalation.
Main Results:
- Antimicrobial stewardship programs (ASPs) are effective in preventing resistance and optimizing clinical outcomes.
- Multidisciplinary teamwork is fundamental for successful ASP implementation.
- Specific strategies like education, clinical pathways, prospective audits, and formulary restrictions are vital.
Conclusions:
- Implementing comprehensive ASPs in NICUs is essential for combating antimicrobial resistance.
- Optimizing antibiotic prescribing through ASPs improves patient outcomes and reduces associated morbidities.
- A collaborative, multifaceted approach is key to successful antimicrobial stewardship in neonates.