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Strategies to improve antibiotic use in the neonatal ICU
Zachary Willis1, Annabelle de St Maurice2
1Division of Pediatric Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina.
Insights
Neonates face high infection risks, leading to significant antimicrobial exposure and potential complications. Advances in antibiotic stewardship aim to optimize antimicrobial use and reduce risks in the neonatal intensive care unit (NICU) population.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Neonates have a high risk of infection and nonspecific sepsis signs, leading to substantial antimicrobial exposure.
- Antibiotic exposure in neonates can cause both short-term and long-term complications.
- Antimicrobial use varies significantly across neonatal intensive care units (NICUs).
Purpose of the Study:
- To review advances in antibiotic stewardship specifically for the neonatal population.
- To highlight strategies for optimizing antimicrobial use in neonates.
- To address the challenges and future directions in neonatal antimicrobial stewardship.
Main Methods:
- Review of recent publications on antibiotic stewardship in neonates.
- Analysis of current practices in antimicrobial utilization in NICUs.
- Evaluation of novel diagnostic methods and biomarkers for infection detection.
Main Results:
- Decreased rates of early-onset sepsis due to Group B Streptococcus with intrapartum antibiotic prophylaxis.
- Development of evidence-based tools for estimating neonatal sepsis risk.
- Variable antibiotic selection and duration for late-onset sepsis and necrotizing enterocolitis, lacking strong evidence.
- Successful implementation of antimicrobial stewardship programs in neonatal settings.
- Challenges remain in universal implementation and further improvement of antibiotic use.
Conclusions:
- Strategies exist to safely reduce antimicrobial exposure in neonates.
- Antimicrobial stewardship interventions in neonatal settings have shown success.
- Further innovation and universal implementation are needed to optimize neonatal antibiotic use.
Purpose Of Review:
Neonates are at a high risk of infection and may have nonspecific signs of sepsis. Accordingly, they are heavily exposed to antimicrobials. Neonates are also uniquely at risk of both short-term and long-term complications from antibiotic exposure. This review discusses advances in antibiotic stewardship in the neonatal population.
Recent Findings:
Antimicrobial utilization is highly variable among NICUs in excess of case-mix variation. Rates of early-onset sepsis because of Group B Streptococcus have decreased substantially with the introduction of intrapartum antibiotic prophylaxis. Recent epidemiologic studies have created evidence-based tools to more accurately estimate a newborn's risk of early-onset sepsis. Antibiotic selection and duration for late-onset sepsis and necrotizing enterocolitis are variable among centers, with inadequate evidence to guide practice. Novel diagnostic methods and biomarkers are increasingly used to assist with diagnosing infection, but inadequate specificity in many cases may result in excess antibiotic exposure. Published antimicrobial stewardship experiences in the neonatal inpatient setting have largely been successful and well tolerated.
Summary:
Recent publications have identified many ways to safely reduce antimicrobial exposure and developed strategies to implement antimicrobial stewardship in the neonatal inpatient setting. However, new approaches are needed to further improve antibiotic use and to implement these interventions more universally in NICUs.
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