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
Author
Prusakov, Pavel; Goff, Debra A.; Wozniak, Phillip S.; Cassim, Azraa; Scipion, Catherine E. A.; Urzua, Soledad; Ronchi, Andrea; Zeng, Lingkong; Ladipo-Ajayi, Oluwaseun; Aviles-Otero, Noelia; Udeigwe-Okeke, Chisom R.; Melamed, Rimma; Silveira, Rita C.; Auriti, Cinzia; Beltran-Arroyave, Claudia; Zamora-Flores, Elena; Sanchez-Codez, Maria; Donkor, Eric S.; Kekomaki, Satu; Mainini, Nicoletta; Trochez, Rosalba Vivas; Casey, Jamalyn; Graus, Juan M.; Muller, Mallory; Singh, Sara; Loeffen, Yvette; Tamayo Perez, Maria Eulalia; Ferreyra, Gloria Isabel; Lima-Rogel, Victoria; Perrone, Barbara; Izquierdo, Giannina; Cernada, Maria; Stoffella, Sylvia; Ekenze, Sebastian Okwuchukwu; de Alba-Romero, Concepcion; Tzialla, Chryssoula; Pham, Jennifer T.; Hosoi, Kenichiro; Consuegra, Magdalena Cecilia Calero; Betta, Pasqua; Hoyos, O. Alvaro; Roilides, Emmanuel; Naranjo-Zuniga, Gabriela; Oshiro, Makoto; Garay, Victor; Mondi, Vito; Mazzeo, Danila; Stahl, James A.; Cantey, Joseph B.; Monsalve, Juan Gonzalo Mesa; Normann, Erik; Landgrave, Lindsay C.; Mazouri, Ali; Avila, Claudia Alarcon; Piersigilli, Fiammetta; Trujillo, Monica; Kolman, Sonya; Delgado, Veronica; Guzman, Veronica; Abdellatif, Mohamed; Monterrosa, Luis; Tina, Lucia Gabriella; Yunis, Khalid; Belzu Rodriguez, Marco Antonio; Le Saux, Nicole; Leonardi, Valentina; Porta, Alessandro; Latorre, Giuseppe; Nakanishi, Hidehiko; Meir, Michal; Manzoni, Paolo; Norero, Ximena; Hoyos, Angela; Arias, Diana; Sanchez, Ruben Garcia; Medoro, Alexandra K.; Sanchez, Pablo J.
Source
eClinicalMedicine. 32
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.