Antimicrobial utilisation patterns between 2013 and 2022 in Canadian neonates born at less than 33 weeks gestation: a...

Area of Science:

• Neonatal intensive care
• Pediatric pharmacology
• Public health initiatives

Background:

• Excessive antimicrobial exposure in neonates is linked to increased mortality, morbidities, and adverse neurodevelopment.
• The Canadian Neonatal Network promotes judicious antimicrobial use via Evidence-based Practice for Improving Quality (EPIQ) processes.
• Evaluating antimicrobial consumption in Canadian tertiary neonatal intensive care units (NICUs) over the past decade is crucial.

Purpose of the Study:

• To evaluate antimicrobial consumption trends among neonates in Canadian tertiary NICUs.
• To assess the impact of quality improvement initiatives on antimicrobial utilization rates (AUR).
• To analyze changes in AUR before and after network-wide interventions.

Main Methods:

• Retrospective cohort study of very preterm infants (<33 weeks gestational age) from 2013-2022.
• Antimicrobial Utilization Rate (AUR) benchmarking initiated in 2016 with ongoing quality improvement.
• Interrupted time-series analysis comparing pre-intervention (2013-2017) and post-intervention (2018-2022) periods.

Main Results:

• A total of 41,253 infants were included; AUR decreased from 184 to 152 (p < 0.0001) post-intervention.
• For infants without culture-proven sepsis or severe necrotizing enterocolitis, AUR decreased from 136 to 110 (p < 0.0001).
• Significant AUR reductions were observed across all subgroups, including those born at <29 weeks gestational age.

Conclusions:

• Comprehensive, network-wide quality improvement initiatives successfully reduced antimicrobial use in preterm infants.
• These initiatives led to a significant and sustained decrease in antimicrobial consumption.
• The findings support the effectiveness of evidence-based quality improvement in optimizing antimicrobial stewardship in NICUs.