Zachary Willis1, Annabelle de St Maurice2. 1. Division of Pediatric Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina. 2. Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California Los Angeles, Los Angeles, California, USA.
Abstract
PURPOSE OF REVIEW: Neonates are at a high risk of infection and may have nonspecific signs of sepsis. Accordingly, they are heavily exposed to antimicrobials. Neonates are also uniquely at risk of both short-term and long-term complications from antibiotic exposure. This review discusses advances in antibiotic stewardship in the neonatal population. RECENT FINDINGS: Antimicrobial utilization is highly variable among NICUs in excess of case-mix variation. Rates of early-onset sepsis because of Group B Streptococcus have decreased substantially with the introduction of intrapartum antibiotic prophylaxis. Recent epidemiologic studies have created evidence-based tools to more accurately estimate a newborn's risk of early-onset sepsis. Antibiotic selection and duration for late-onset sepsis and necrotizing enterocolitis are variable among centers, with inadequate evidence to guide practice. Novel diagnostic methods and biomarkers are increasingly used to assist with diagnosing infection, but inadequate specificity in many cases may result in excess antibiotic exposure. Published antimicrobial stewardship experiences in the neonatal inpatient setting have largely been successful and well tolerated. SUMMARY: Recent publications have identified many ways to safely reduce antimicrobial exposure and developed strategies to implement antimicrobial stewardship in the neonatal inpatient setting. However, new approaches are needed to further improve antibiotic use and to implement these interventions more universally in NICUs.
PURPOSE OF REVIEW: Neonates are at a high risk of infection and may have nonspecific signs of sepsis. Accordingly, they are heavily exposed to antimicrobials. Neonates are also uniquely at risk of both short-term and long-term complications from antibiotic exposure. This review discusses advances in antibiotic stewardship in the neonatal population. RECENT FINDINGS: Antimicrobial utilization is highly variable among NICUs in excess of case-mix variation. Rates of early-onset sepsis because of Group B Streptococcus have decreased substantially with the introduction of intrapartum antibiotic prophylaxis. Recent epidemiologic studies have created evidence-based tools to more accurately estimate a newborn's risk of early-onset sepsis. Antibiotic selection and duration for late-onset sepsis and necrotizing enterocolitis are variable among centers, with inadequate evidence to guide practice. Novel diagnostic methods and biomarkers are increasingly used to assist with diagnosing infection, but inadequate specificity in many cases may result in excess antibiotic exposure. Published antimicrobial stewardship experiences in the neonatal inpatient setting have largely been successful and well tolerated. SUMMARY: Recent publications have identified many ways to safely reduce antimicrobial exposure and developed strategies to implement antimicrobial stewardship in the neonatal inpatient setting. However, new approaches are needed to further improve antibiotic use and to implement these interventions more universally in NICUs.
Authors: Shelley S Magill; Erin O'Leary; Susan M Ray; Marion A Kainer; Christopher Evans; Wendy M Bamberg; Helen Johnston; Sarah J Janelle; Tolulope Oyewumi; Ruth Lynfield; Jean Rainbow; Linn Warnke; Joelle Nadle; Deborah L Thompson; Shamima Sharmin; Rebecca Pierce; Alexia Y Zhang; Valerie Ocampo; Meghan Maloney; Samantha Greissman; Lucy E Wilson; Ghinwa Dumyati; Jonathan R Edwards Journal: Clin Infect Dis Date: 2021-05-18 Impact factor: 9.079