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Published on: August 30, 2018
Antimicrobial Stewardship: A Correct Management to Reduce Sepsis in NICU Settings
Veronica Notarbartolo1, Bintu Ayla Badiane2, Vincenzo Insinga1
1Neonatology and Neonatal Intensive Care Unit, University Hospital "Paolo Giaccone", 90127 Palermo, Italy.
Insights
Antimicrobial drugs are vital in Neonatal Intensive Care Units (NICUs) but overuse causes antimicrobial resistance (AMR) and health issues. Judicious use, guided by stewardship programs, is essential for newborns.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Antimicrobial drugs significantly improve survival rates from infections.
- Newborns possess immature immune systems, making them highly susceptible to infections.
- Antimicrobial use in Neonatal Intensive Care Units (NICUs) is often life-saving but frequently overprescribed.
Purpose of the Study:
- To review the critical balance between antimicrobial therapy risks and benefits in NICUs.
- To highlight the impact of antibiotic misuse on neonatal health and antimicrobial resistance (AMR).
- To advocate for optimized antimicrobial use through specific strategies.
Main Methods:
- This study is a narrative review.
- It synthesizes current knowledge on antimicrobial use in neonatal care.
- It discusses the implications of antibiotic misuse and potential solutions.
Main Results:
- Overuse of antimicrobials in neonates contributes to AMR and adverse health outcomes, including microbiota alterations and increased risks of allergies and obesity.
- Prompt antimicrobial administration is crucial for severe infections like sepsis in newborns.
- Decision-making tools and electronic calculators can help reduce unnecessary antibiotic prescriptions.
Conclusions:
- Strict necessity should guide antibiotic use in neonates.
- Implementing Antimicrobial Stewardship Programs (ASPs) and dedicated teams in NICUs is crucial.
- Balancing the benefits and risks of antimicrobial therapy is paramount for neonatal patient care and combating AMR.
Abstract:
The discovery of antimicrobial drugs has led to a significant increase in survival from infections; however, they are very often prescribed and administered, even when their use is not necessary and appropriate. Newborns are particularly exposed to infections due to the poor effectiveness and the immaturity of their immune systems. For this reason, in Neonatal Intensive Care Units (NICUs), the use of antimicrobial drugs is often decisive and life-saving, and it must be started promptly to ensure its effectiveness in consideration of the possible rapid evolution of the infection towards sepsis. Nevertheless, the misuse of antibiotics in the neonatal period leads not only to an increase in the development and wide spreading of antimicrobial resistance (AMR) but it is also associated with various short-term (e.g., alterations of the microbiota) and long-term (e.g., increased risk of allergic disease and obesity) effects. It appears fundamental to use antibiotics only when strictly necessary; specific decision-making algorithms and electronic calculators can help limit the use of unnecessary antibiotic drugs. The aim of this narrative review is to summarize the right balance between the risks and benefits of antimicrobial therapy in NICUs; for this purpose, specific Antimicrobial Stewardship Programs (ASPs) in neonatal care and the creation of a specific antimicrobial stewardship team are requested.
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