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Published on: August 30, 2018
Effectiveness of antimicrobial stewardship programmes in neonatology: a systematic review
André Ricardo Araujo da Silva1, Amanda Marques2, Clara Di Biase2
1Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil aricardo@id.uff.br.
Insights
Antimicrobial stewardship programmes (ASPs) effectively reduce antibiotic use and broad-spectrum antibiotic prescribing in neonatal settings. However, their impact on antimicrobial resistance and healthcare-associated infections requires further long-term investigation.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Public Health
Background:
- Antimicrobial resistance (AMR) is a growing global health threat.
- Antimicrobial stewardship programmes (ASPs) are crucial for optimizing antibiotic use in healthcare settings.
- Neonatal populations are particularly vulnerable to infections and antibiotic-related complications.
Purpose of the Study:
- To evaluate the effectiveness of ASPs in neonatal wards and neonatal intensive care units (NICUs).
- To assess the impact of ASPs on antibiotic consumption, use of broad-spectrum antibiotics, AMR, and healthcare-associated infections (HAIs) in neonates.
Main Methods:
- A systematic literature search was conducted in PubMed, SciELO, EMBASE, and the Cochrane Database (January 2000-April 2019).
- Studies focused on ASPs in neonatal settings, excluding those in non-acute care, older children, or addressing antifungals/antivirals.
- Six publications met the inclusion criteria, with five conducted exclusively in NICUs and four employing multimodal interventions.
Main Results:
- Four studies reported a reduction in overall antibiotic consumption or inappropriate antibiotic use.
- Four studies indicated a decrease in the use of broad-spectrum or targeted antibiotics.
- No studies evaluated the impact of ASPs on antimicrobial resistance or the incidence of HAIs in neonates.
Conclusions:
- ASPs are feasible and effective in neonatal settings for reducing antibiotic consumption and broad-spectrum agent use.
- Limiting broad-spectrum antibiotic use and shortening treatment duration are promising strategies.
- Long-term studies are necessary to determine the impact of ASPs on AMR and HAIs in neonates.
Introduction:
Antimicrobial stewardship programmes (ASPs) are recommended to improve antibiotic use in healthcare and reduce antimicrobial resistance (AMR). Our aim was to investigate the effectiveness of ASPs in reducing antibiotic consumption, use of broad-spectrum/restricted antibiotics, antibiotic resistance and healthcare-associated infections (HAIs) in neonates.
Methods:
We searched PUBMED, SCIELO, EMBASE and the Cochrane Database (January 2000-April 2019) to identify studies on the effectiveness of ASPs in neonatal wards and/or neonatal intensive care units (NICUs). Outcomes were as follows: reduction of antibiotic consumption overall and of broad-spectrum/target antibiotics, inappropriate antibiotic use, antibiotic resistance and HAIs. ASPs conducted in settings other than acute care hospitals, for children older than 1 month, and ASPs addressing antifungal and antiviral agents, were excluded.
Results:
The initial search identified 53 173 titles and abstracts; following the application of filters and inclusion criteria, a total of six publications were included in the final analysis. All studies, of which one was multi-centre study, were published after 2010. Five studies were conducted exclusively in NICUs. Four articles applied multimodal interventions. Reduction of antibiotic consumption overall and/or inappropriate antibiotic use were reported by four articles; reduction of broad-spectrum/targeted antibiotics were reported by four studies; No article evaluated the impact of ASPs on AMR or the incidence of HAI in neonates.
Conclusion:
ASPs can be effectively applied in neonatal settings. Limiting the use of broad-spectrum antibiotics and shorting the duration of antibiotic treatment are the most promising approaches. The impact of ASPs on AMR and HAI needs to be evaluated in long-term studies.
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