Antimicrobial stewardship in NICUs of low- and lower-middle-income countries - A narrative review

Area of Science:

• Neonatal Health
• Infectious Diseases
• Antimicrobial Stewardship

Background:

• Neonatal sepsis is a significant global health challenge, particularly in low- and lower-middle-income countries (LMICs).
• Limited diagnostic capabilities in these regions often lead to empiric antibiotic use in neonatal intensive care units (NICUs).
• Widespread empiric antibiotic use contributes to the growing problem of antimicrobial resistance.

Purpose of the Study:

• To review existing literature on strategies aimed at reducing empiric antibiotic use in neonatal intensive care units (NICUs).
• To assess the impact of reduced antibiotic exposure on neonatal outcomes, including mortality and sepsis recurrence.

Main Methods:

• A systematic review of 19 reports was conducted.
• The review focused on studies implementing interventions to decrease antibiotic usage in neonatal intensive care units (NICUs).
• Outcomes analyzed included mortality, sepsis recurrence, necrotising enterocolitis, and re-admissions.

Main Results:

• Reduced antibiotic use in neonatal intensive care units (NICUs) was not associated with increased mortality.
• There was no significant increase in sepsis recurrence, necrotising enterocolitis, or re-admissions following antibiotic reduction.
• These findings suggest that antimicrobial stewardship interventions are feasible and safe in LMICs.

Conclusions:

• Strategies to curb empiric antibiotic use in neonatal intensive care units (NICUs) are effective and do not compromise patient safety.
• Reducing unnecessary antibiotic exposure is crucial for combating antimicrobial resistance in neonatal populations.
• Further implementation of antimicrobial stewardship programs in LMICs is warranted to address both sepsis burden and resistance.