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Evaluation of antibiotic stewardship among near-term and term infants admitted to a neonatal unit

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Abstract

To evaluate the safety and effectiveness of evidence-based antibiotic stewardship in a neonatal unit in China. The study period consisted of two phases, one retrospective (the baseline period, January to December 2018, and the transition period, January 2019 to August 2020) and one prospective intervention period (September 2020 to August 2021). During the prospective period, evidence-based antibiotic stewardship was applied to neonates with suspected infections, pneumonia, and culture-negative sepsis. The antibiotic stewardship included the observation form of neonatal infections, antibiotic therapy of no more than 48 h for suspected infections, and 5 days for pneumonia and culture-negative sepsis. The change in antibiotic use measured by days of therapy per 1000 patient-days between the baseline and intervention period was analyzed. Safety outcomes included reinitiation of antibiotics within 14 days, length of stay, occurrence of late-onset sepsis and necrotizing enterocolitis (Bell stage ≥ II), multidrug-resistant organism infections, and mortality. A total of 7705 neonates were enrolled during the baseline (n = 4804) and the intervention periods (n = 2901). The total antibiotic usage during the baseline period was 771 days of therapy per 1000 patient-days, while that was 525 days of therapy per 1000 patient-days during the intervention period, indicating a 32% decrease in antibiotic consumption. No significant difference in safety outcomes was observed between the baseline and intervention period (P > 0.05), whereas the length of stay was longer during the intervention period (P < 0.001).

Conclusion: The evidence-based antibiotic stewardship can safely and effectively reduce antibiotic use and shorten the duration of therapy in the neonatal unit.

What is Known:

• Overuse of antibiotics has been associated with adverse events in neonates, including necrotizing enterocolitis, multidrug-resistant organism infections, and death.

• More clinical effectiveness evidence is needed to support antibiotic stewardship of neonates in China.

What is New:

• Using prospective audit, targeted stewardship interventions, this study shows that a 32% reduction in overall antibiotic consumption was achieved safely.

• Implementation of evidence-based neonatal antibiotic stewardship, including the observation form of neonatal infections, antibiotic therapy of no more than 48 h for suspected infections, and 5 days for pneumonia and culture-negative sepsis, is safe and effective among newborns in a developing country.

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Abbreviations

CHCMU:

Children’s Hospital of Chongqing Medical University

CRP:

C-reactive protein

DW:

Durbin-Watson method

EOS:

Early-onset sepsis

LOS:

Late-onset sepsis

NEC:

Necrotizing enterocolitis

PCT:

Procalcitonin

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Funding

This study was supported by grants from the Clinical Research Project of Children’s Hospital of Chongqing Medical University (grant number YBXM 2019–007). The funder had no involvement in the preparation of data or the manuscript.

Author information

Authors and Affiliations

  1. Department of Neonatology, Children’s Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Er Rd, Yuzhong District, Chongqing, 400014, China

    Kun Feng, Yunyan He, Weiqin Liu, Xinyin Zhang & Ziyu Hua

  2. Children’s Medical Big Data Intelligent Application, Chongqing University Engineering Research Center, Chongqing, 400014, China

    Ping Song

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  1. Kun Feng
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Contributions

Kun Feng conceptualized and designed this study, performed data collection, analysis, and visualization, and contributed to writing the draft and revising the manuscript. Yunyan He and Xinyin Zhang contributed to conceptualization, data collection, and to writing the original draft. Weiqin Liu contributed to conceptualization, data analysis and visualization, and to revising the manuscript. Ping Song contributed to conceptualization, data collection, and reviewed the manuscript. Ziyu Hua supervised the study design, acquired the funding, conceptualized this study, contributed to data analysis and revised the manuscript. All authors approved the final manuscript as submitted.

Corresponding author

Correspondence to Ziyu Hua.

Ethics declarations

Ethics approval

The Institutional Review Board of CHCMU approved the study (Approval No. 2020–197-1) with a waiver of informed consent.

Consent statement

Patient consent was not required.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Peter de Winter

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Feng, K., He, Y., Liu, W. et al. Evaluation of antibiotic stewardship among near-term and term infants admitted to a neonatal unit. Eur J Pediatr 182, 245–254 (2023). https://doi.org/10.1007/s00431-022-04668-5

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