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Published on: August 30, 2018
Sustaining the Continued Effectiveness of an Antimicrobial Stewardship Program in Preterm Infants
Tommaso Zini1, Francesca Miselli1,2, Chiara D'Esposito3
1Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy.
Insights
Antimicrobial stewardship (AS) programs effectively reduce antibiotic use in very-low-birth-weight (VLBW) infants. These interventions, including shorter antibiotic courses, can be sustained long-term in neonatal intensive care units (NICUs) with ongoing staff engagement.
Area of Science:
- Neonatalogy
- Infectious Diseases
- Public Health
Background:
- Antibiotic use varies significantly in neonatal intensive care units (NICUs).
- Limited data exist on antimicrobial stewardship (AS) programs for preterm very-low-birth-weight (VLBW) infants.
- Long-term maintenance of AS interventions in this vulnerable population is not well-documented.
Purpose of the Study:
- To evaluate the feasibility and long-term impact of an antimicrobial stewardship (AS) program in preterm VLBW infants.
- To assess the sustainability of reduced antibiotic exposure through AS interventions.
- To analyze antibiotic use patterns across different study periods in a NICU setting.
Main Methods:
- A single-centre observational study in an Italian NICU compared three periods: baseline (2011-2012), intervention (2016-2017), and maintenance (2020-2021).
- Intensive staff training on AS was conducted between the baseline and intervention periods.
- AS protocols were maintained and implemented between the intervention and maintenance periods.
Main Results:
- Antibiotic use, measured as days of therapy per 1000 patient days, decreased significantly during the intervention period (215 vs. 302, p < 0.01).
- The median duration of early empiric antibiotics was reduced (6 days baseline vs. 3 intervention vs. 2 maintenance, p < 0.001).
- Antibiotics for culture-negative sepsis decreased (22% baseline vs. 11% intervention vs. 6% maintenance, p = 0.002), particularly in infants weighing 1000-1499g.
Conclusions:
- Antimicrobial stewardship is feasible and safe in preterm VLBW infants, leading to reduced antibiotic use.
- AS interventions, such as shortening antibiotic courses for uninfected infants, can be sustained over time.
- Periodic clinical audits and daily staff discussions are crucial for maintaining AS effectiveness.
Background:
There are wide variations in antibiotic use in neonatal intensive care units (NICUs). Limited data are available on antimicrobial stewardship (AS) programs and long-term maintenance of AS interventions in preterm very-low-birth-weight (VLBW) infants.
Methods:
We extended a single-centre observational study carried out in an Italian NICU. Three periods were compared: I. "baseline" (2011-2012), II. "intervention" (2016-2017), and III. "maintenance" (2020-2021). Intensive training of medical and nursing staff on AS occurred between periods I and II. AS protocols and algorithms were maintained and implemented between periods II and III.
Results:
There were 111, 119, and 100 VLBW infants in periods I, II, and III, respectively. In the "intervention period", there was a reduction in antibiotic use, reported as days of antibiotic therapy per 1000 patient days (215 vs. 302, p < 0.01). In the "maintenance period", the number of culture-proven sepsis increased. Nevertheless, antibiotic exposure of uninfected VLBW infants was lower, while no sepsis-related deaths occurred. Our restriction was mostly directed at shortening antibiotic regimens with a policy of 48 h rule-out sepsis (median days of early empiric antibiotics: 6 vs. 3 vs. 2 in periods I, II, and III, respectively, p < 0.001). Moreover, antibiotics administered for so-called culture-negative sepsis were reduced (22% vs. 11% vs. 6%, p = 0.002), especially in infants with a birth weight between 1000 and 1499 g.
Conclusions:
AS is feasible in preterm VLBW infants, and antibiotic use can be safely reduced. AS interventions, namely, the shortening of antibiotic courses in uninfected infants, can be sustained over time with periodic clinical audits and daily discussion of antimicrobial therapies among staff members.
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