Antibiotic Stewardship in Premature Infants: A Systematic Review

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Public Health

Background:

• Antibiotic overuse in premature infants is common in neonatal intensive care units, leading to serious side effects and potential long-term adverse health outcomes.
• Antibiotic stewardship programs (ASPs) are a preventive measure to reduce unnecessary antibiotic exposure in vulnerable infant populations.
• This review focuses on ASPs implemented in premature infants with gestational age ≤34 weeks.

Approach:

• A systematic literature search was conducted across six major academic databases, adhering to PRISMA guidelines.
• Twelve studies (11 observational, 1 RCT) met the inclusion criteria after screening 1,212 titles.
• Articles were critically appraised and grouped by stewardship action: reducing initiation, shortening duration, or organizational implementations.

Key Points:

• Implemented ASPs demonstrated reductions in antibiotic use among premature newborns.
• Multifactorial and tailored programs focusing on reducing antibiotic initiation or duration were most effective.
• Programs lacking specific, targeted measures showed diminished effectiveness.

Conclusions:

• Antibiotic stewardship programs are effective interventions for premature infants.
• Tailored, multifactorial ASPs focusing on antibiotic initiation and duration are recommended for neonatal populations.
• Targeted stewardship strategies are crucial for optimizing antibiotic use and improving outcomes in premature infants.