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Antimicrobial Stewardship at Birth in Preterm Infants: Not Just About a Decrease!

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Antimicrobial Stewardship Programs (ASPs) reduced early antibiotic use in preterm infants. However, some infants with sepsis risk factors were undertreated, highlighting potential unintended consequences of ASP implementation.

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Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Public Health

Background:

  • Early-onset sepsis poses significant risks to preterm infants, increasing morbidity and mortality.
  • Antimicrobial Stewardship Programs (ASPs) aim to optimize antibiotic use, balancing treatment needs with adverse effects.

Purpose of the Study:

  • To evaluate the impact of a neonatal Antimicrobial Stewardship Program (ASP) on antibiotic prescribing practices for preterm infants.
  • To assess changes in empiric antibiotic initiation before and after ASP implementation.

Main Methods:

  • A retrospective review of preterm infants (<34 weeks gestational age) before and after ASP implementation.
  • Comparison of sepsis risk factors and antibiotic treatment rates between pre- and post-ASP cohorts.

Main Results:

  • Fewer infants received initial antibiotics post-ASP implementation (60.4% vs. 69.7%).
  • Antibiotic use appropriately decreased in infants without sepsis risk factors.
  • A concerning proportion of infants with risk factors (e.g., preterm labor, ruptured membranes) did not receive initial antibiotics.

Conclusions:

  • Neonatal ASP implementation led to a reduction in early antibiotic initiation.
  • Potential unintended consequences, including undertreatment of high-risk infants, require careful monitoring.
  • ASP teams must balance antibiotic reduction with ensuring adequate treatment for at-risk neonates.