Antimicrobial stewardship in UK special care baby units: gaps in research and future directions

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Antimicrobial Stewardship

Background:

• Neonatal sepsis remains a concern, leading to antibiotic overprescription despite declining incidence.
• Antimicrobial stewardship is crucial for combating resistance and preventing infant dysbiosis, as per the UK National Action Plan.
• Current research predominantly focuses on high-resource Level 3 Neonatal Intensive Care Units (NICUs).

Purpose of the Study:

• To address the misalignment between current neonatal stewardship research settings and actual clinical practice.
• To explore barriers in transferring stewardship models from intensive care to lower-acuity settings.
• To advocate for the inclusion of Level 1 and 2 neonatal populations in future research.

Main Methods:

• This viewpoint analyzes operational and structural barriers to stewardship model transferability.
• It identifies research gaps in baseline prescribing and multidisciplinary collaboration.
• It reviews the current evidence base for neonatal antimicrobial stewardship.

Main Results:

• Most neonatal stewardship research occurs in Level 3 NICUs, not Level 1 and 2 units where most infants are treated.
• Significant barriers hinder the application of intensive-care stewardship models in lower-acuity settings.
• Key research gaps exist regarding prescribing practices and collaboration in Level 1 and 2 units.

Conclusions:

• There is a critical need to bridge the gap between intensive-care-focused stewardship research and the reality of care in Level 1 and 2 neonatal units.
• Future validation studies for neonatal sepsis diagnostics must incorporate Level 1 and 2 populations.
• Inclusion of all neonatal care settings is essential for effective antimicrobial resistance strategies.