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Sustaining the Continued Effectiveness of an Antimicrobial Stewardship Program in Preterm Infants.
Zini, Tommaso; Miselli, Francesca; D'Esposito, Chiara; Fidanza, Lucia; Cuoghi Costantini, Riccardo; Corso, Lucia; Mazzotti, Sofia; Rossi, Cecilia; Spaggiari, Eugenio; Rossi, Katia; Lugli, Licia; Bedetti, Luca; Berardi, Alberto.
Afiliación
  • Zini T; Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy.
  • Miselli F; Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy.
  • D'Esposito C; PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy.
  • Fidanza L; Degree Program in Medicine and Surgery, University of Modena and Reggio Emilia, 41125 Modena, Italy.
  • Cuoghi Costantini R; Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy.
  • Corso L; PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy.
  • Mazzotti S; Post-Graduate School of Paediatrics, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy.
  • Rossi C; Post-Graduate School of Paediatrics, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy.
  • Spaggiari E; Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy.
  • Rossi K; Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy.
  • Lugli L; Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy.
  • Bedetti L; Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy.
  • Berardi A; Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy.
Trop Med Infect Dis ; 9(3)2024 Mar 07.
Article en En | MEDLINE | ID: mdl-38535883
ABSTRACT

BACKGROUND:

There are wide variations in antibiotic use in neonatal intensive care units (NICUs). Limited data are available on antimicrobial stewardship (AS) programs and long-term maintenance of AS interventions in preterm very-low-birth-weight (VLBW) infants.

METHODS:

We extended a single-centre observational study carried out in an Italian NICU. Three periods were compared I. "baseline" (2011-2012), II. "intervention" (2016-2017), and III. "maintenance" (2020-2021). Intensive training of medical and nursing staff on AS occurred between periods I and II. AS protocols and algorithms were maintained and implemented between periods II and III.

RESULTS:

There were 111, 119, and 100 VLBW infants in periods I, II, and III, respectively. In the "intervention period", there was a reduction in antibiotic use, reported as days of antibiotic therapy per 1000 patient days (215 vs. 302, p < 0.01). In the "maintenance period", the number of culture-proven sepsis increased. Nevertheless, antibiotic exposure of uninfected VLBW infants was lower, while no sepsis-related deaths occurred. Our restriction was mostly directed at shortening antibiotic regimens with a policy of 48 h rule-out sepsis (median days of early empiric antibiotics 6 vs. 3 vs. 2 in periods I, II, and III, respectively, p < 0.001). Moreover, antibiotics administered for so-called culture-negative sepsis were reduced (22% vs. 11% vs. 6%, p = 0.002), especially in infants with a birth weight between 1000 and 1499 g.

CONCLUSIONS:

AS is feasible in preterm VLBW infants, and antibiotic use can be safely reduced. AS interventions, namely, the shortening of antibiotic courses in uninfected infants, can be sustained over time with periodic clinical audits and daily discussion of antimicrobial therapies among staff members.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Trop Med Infect Dis Año: 2024 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Suiza
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Trop Med Infect Dis Año: 2024 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Suiza