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Reduction of antibiotic use and multi-drug resistance bacteria infection in neonates after improvement of antibiotics use strategy in a level 4 neonatal intensive care unit in southern China

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Abstract

The investigation on antibiotic stewardship in neonatal intensive care unit in China is scarce. This study aimed to analyze the effect of a comprehensive 2-year antibiotic stewardship in a level 4 NICU. During this baseline period from October 1st 2017 to October 1st 2019, continuation of empirical antibiotic therapy for ruled-out sepsis courses was beyond 72 h and for pneumonia was more than 7 days. Meropenem or vancomycin was used even if they were not the only bacterial sensitive antibiotics. The intervention period was from October 2nd 2019 to August 23rd 2021. Three areas for quality improvement were targeted in our center: discontinuation of antibiotic use in ruled-out sepsis within 72 h, treatment duration for culture-negative pneumonia less than 7 days, and vancomycin or meropenem was not used unless the cultured bacteria was only susceptible to them. The total antibiotic consumption decreased from 791.1 to 466.3 days of therapy per 1000 patient days from baseline to intervention period. Antibiotics were stopped within 72 h for 47.48% patients with rule-out sepsis and within 7 days for 75.70% patients with pneumonia compared with 11.56% and 37.69% during the baseline period respectively. The prevalence of multi-drug resistance bacteria decreased from 67.20 to 48.90%. The total use rate of meropenem or vancomycin decreased from 7.6 to 1.8%. Our quality improvement approach on antibiotic strategy significantly reduced antibiotic use and prevalence of multi-drug resistance bacteria in our NICU.

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Availability of data and material

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This study is funded by National Key R&D Program of China (NO.2021YFC2701700), Guangzhou Science Project (202102080104). The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

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Author notes

  1. Zhuxiao Ren, Shumei Yang, Jiangxue Han, Chuan Nie, and Cuicui Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China

    Zhuxiao Ren, Shumei Yang, Jiangxue Han, Chuan Nie, Cuicui Wang, Jianlan Wang, Xuaner Zheng, Haoming Yang, Fang Xu & Jie Yang

  2. Guangdong Neonatal ICU Medical Quality Control Center, Guangdong Women and Children Hospital, Guangzhou, China

    Zhuxiao Ren, Shumei Yang, Chuan Nie & Fang Xu

  3. Department of Clinical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, China

    Qi Zhang

  4. Department of Neonatology, Nanfang Hospital, Southern Medical University, Guangzhou, China

    Jingjun Pei & Jie Yang

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  1. Zhuxiao Ren
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  11. Fang Xu
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Contributions

XF, YS, and ZX performed the trials, YH, WJ and HJ, ZQ, YH, WC, and PJ collected and analyzed data and collected the references, RZ was a major contributor in writing the manuscript, and YJ and NC designed this study and edited the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Fang Xu or Jie Yang.

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Guangdong Women and Children Hospital Ethics committee, Number 202201127.

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The authors declare no competing interests.

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Ren, Z., Yang, S., Han, J. et al. Reduction of antibiotic use and multi-drug resistance bacteria infection in neonates after improvement of antibiotics use strategy in a level 4 neonatal intensive care unit in southern China. Eur J Clin Microbiol Infect Dis 42, 87–98 (2023). https://doi.org/10.1007/s10096-022-04522-4

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