학술논문
A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study
Document Type
article
Author
Pavel Prusakov, PharmD; Debra A. Goff, PharmD; Phillip S. Wozniak, BA; Azraa Cassim, BPharm; Catherine E.A. Scipion, MD; Soledad Urzúa, MD; Andrea Ronchi, MD; Lingkong Zeng, MD; Oluwaseun Ladipo-Ajayi, MBChB; Noelia Aviles-Otero, MD; Chisom R. Udeigwe-Okeke, MBBS; Rimma Melamed, MD; Rita C. Silveira, MD; Cinzia Auriti, MD; Claudia Beltrán-Arroyave, MD; Elena Zamora-Flores, MD; Maria Sanchez-Codez, MD; Eric S. Donkor, PhD; Satu Kekomäki, MD; Nicoletta Mainini, MD; Rosalba Vivas Trochez, MD; Jamalyn Casey, PharmD; Juan M. Graus, MD; Mallory Muller, PharmD; Sara Singh, MBBS; Yvette Loeffen, MD; María Eulalia Tamayo Pérez, MD; Gloria Isabel Ferreyra, MD; Victoria Lima-Rogel, MD; Barbara Perrone, MD; Giannina Izquierdo, MD; María Cernada, MD; Sylvia Stoffella, PharmD; Sebastian Okwuchukwu Ekenze, MD; Concepción de Alba-Romero, MD; Chryssoula Tzialla, MD; Jennifer T. Pham, PharmD; Kenichiro Hosoi, MD; Magdalena Cecilia Calero Consuegra, MD; Pasqua Betta, MD; O. Alvaro Hoyos, MD; Emmanuel Roilides, MD; Gabriela Naranjo-Zuñiga, MD; Makoto Oshiro, MD; Victor Garay, MD; Vito Mondì, MD; Danila Mazzeo, MD; James A. Stahl, PharmD; Joseph B. Cantey, MD; Juan Gonzalo Mesa Monsalve, MD; Erik Normann, MD; Lindsay C. Landgrave, PharmD; Ali Mazouri, MD; Claudia Alarcón Avila, MD; Fiammetta Piersigilli, MD; Monica Trujillo, MD; Sonya Kolman, BPharm; Verónica Delgado, MD; Veronica Guzman, MD; Mohamed Abdellatif, FRCPCH; Luis Monterrosa, MD; Lucia Gabriella Tina, MD; Khalid Yunis, MD; Marco Antonio Belzu Rodriguez, MD; Nicole Le Saux, MD; Valentina Leonardi, MD; Alessandro Porta, MD; Giuseppe Latorre, MD; Hidehiko Nakanishi, MD; Michal Meir, MD; Paolo Manzoni, MD; Ximena Norero, MD; Angela Hoyos, MD; Diana Arias, MD; Rubén García Sánchez, MD; Alexandra K. Medoro, MD; Pablo J. Sánchez
Source
EClinicalMedicine, Vol 32, Iss , Pp 100727- (2021)
Subject
Language
English
ISSN
2589-5370
Abstract
Background: Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. Methods: We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. Findings: On July 1, 2019, 26% of infants (580/2,265; range, 0–100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received ≥1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were “rule-out” sepsis (32%) and “culture-negative” sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and “culture-negative” infections was 12 days (median; IQR, 8–14) and 7 days (median; IQR, 5–10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0·02). Interpretation: Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide. Funding: Merck & Co.; The Ohio State University College of Medicine Barnes Medical Student Research Scholarship