EClinicalMedicine (Feb 2021)
A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study
- Pavel Prusakov, PharmD,
- Debra A. Goff, PharmD,
- Phillip S. Wozniak, BA,
- Azraa Cassim, BPharm,
- Catherine E.A. Scipion, MD,
- Soledad Urzúa, MD,
- Andrea Ronchi, MD,
- Lingkong Zeng, MD,
- Oluwaseun Ladipo-Ajayi, MBChB,
- Noelia Aviles-Otero, MD,
- Chisom R. Udeigwe-Okeke, MBBS,
- Rimma Melamed, MD,
- Rita C. Silveira, MD,
- Cinzia Auriti, MD,
- Claudia Beltrán-Arroyave, MD,
- Elena Zamora-Flores, MD,
- Maria Sanchez-Codez, MD,
- Eric S. Donkor, PhD,
- Satu Kekomäki, MD,
- Nicoletta Mainini, MD,
- Rosalba Vivas Trochez, MD,
- Jamalyn Casey, PharmD,
- Juan M. Graus, MD,
- Mallory Muller, PharmD,
- Sara Singh, MBBS,
- Yvette Loeffen, MD,
- María Eulalia Tamayo Pérez, MD,
- Gloria Isabel Ferreyra, MD,
- Victoria Lima-Rogel, MD,
- Barbara Perrone, MD,
- Giannina Izquierdo, MD,
- María Cernada, MD,
- Sylvia Stoffella, PharmD,
- Sebastian Okwuchukwu Ekenze, MD,
- Concepción de Alba-Romero, MD,
- Chryssoula Tzialla, MD,
- Jennifer T. Pham, PharmD,
- Kenichiro Hosoi, MD,
- Magdalena Cecilia Calero Consuegra, MD,
- Pasqua Betta, MD,
- O. Alvaro Hoyos, MD,
- Emmanuel Roilides, MD,
- Gabriela Naranjo-Zuñiga, MD,
- Makoto Oshiro, MD,
- Victor Garay, MD,
- Vito Mondì, MD,
- Danila Mazzeo, MD,
- James A. Stahl, PharmD,
- Joseph B. Cantey, MD,
- Juan Gonzalo Mesa Monsalve, MD,
- Erik Normann, MD,
- Lindsay C. Landgrave, PharmD,
- Ali Mazouri, MD,
- Claudia Alarcón Avila, MD,
- Fiammetta Piersigilli, MD,
- Monica Trujillo, MD,
- Sonya Kolman, BPharm,
- Verónica Delgado, MD,
- Veronica Guzman, MD,
- Mohamed Abdellatif, FRCPCH,
- Luis Monterrosa, MD,
- Lucia Gabriella Tina, MD,
- Khalid Yunis, MD,
- Marco Antonio Belzu Rodriguez, MD,
- Nicole Le Saux, MD,
- Valentina Leonardi, MD,
- Alessandro Porta, MD,
- Giuseppe Latorre, MD,
- Hidehiko Nakanishi, MD,
- Michal Meir, MD,
- Paolo Manzoni, MD,
- Ximena Norero, MD,
- Angela Hoyos, MD,
- Diana Arias, MD,
- Rubén García Sánchez, MD,
- Alexandra K. Medoro, MD,
- Pablo J. Sánchez
Affiliations
- Pavel Prusakov, PharmD
- Department of Pharmacy, Nationwide Children's Hospital, Columbus, OH, USA
- Debra A. Goff, PharmD
- Department of Pharmacy, The Ohio State University Wexner Medical Center, The Ohio State University College of Pharmacy, Columbus, OH, USA
- Phillip S. Wozniak, BA
- The Ohio State University College of Medicine, Columbus, OH, USA
- Azraa Cassim, BPharm
- Chris Hani Baragwanath Hospital, Johannesburg, South Africa
- Catherine E.A. Scipion, MD
- Health Equity International, Fond- des- Blancs, Haiti
- Soledad Urzúa, MD
- Department of Neonatology, Pontificia Universidad Catolica, Santiago, Chile
- Andrea Ronchi, MD
- Division of Neonatology and NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Lingkong Zeng, MD
- Department of Neonatology, Wuhan Children's Hospital Wuhan Maternal and Child Healthcare Hospital Tongji Medical College Huazhong University of Science & Technology, Wuhan, China
- Oluwaseun Ladipo-Ajayi, MBChB
- Department of Pediatric Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
- Noelia Aviles-Otero, MD
- University of Virginia School of Medicine, Charlottesville, VA, USA
- Chisom R. Udeigwe-Okeke, MBBS
- Division of Paediatric Surgery, National Hospital, Abuja, Nigeria
- Rimma Melamed, MD
- Pediatric Infectious Diseases Unit and Faculty of Health Sciences, Ben Gurion University of the Negev, Soroka University Medical Center, Beer Sheva, Israel
- Rita C. Silveira, MD
- Department of Pediatrics, Newborn Section, Universidade Federal do Rio Grande do Sul. Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
- Cinzia Auriti, MD
- Department of Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
- Claudia Beltrán-Arroyave, MD
- Clinica del Prado and Clinica El Rosario, Medellin, Colombia
- Elena Zamora-Flores, MD
- Division of Neonatology, Hospital Materno Infantil Gregorio Marañon University Hospital, Madrid, Spain
- Maria Sanchez-Codez, MD
- Division of Pediatric Infectious Diseases, Puerta del Mar University Hospital, Cadiz, Spain
- Eric S. Donkor, PhD
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
- Satu Kekomäki, MD
- Division of Pediatric Infectious Diseases, Children's Hospital, Helsinki University Hospital, Helsinki, Finland
- Nicoletta Mainini, MD
- Division of Neonatology, Treviso Hospital, Treviso, Italy
- Rosalba Vivas Trochez, MD
- Clinica Soma, Procaren NICU, CES University, Medellin, Colombia
- Jamalyn Casey, PharmD
- Department of Pharmacy, St. Vincent Women's Hospital, Indianapolis, IN, United States
- Juan M. Graus, MD
- Department of Neonatology, Hospital Nacional Cayetano Heredia, Lima, Peru
- Mallory Muller, PharmD
- Department of Pharmacy, Arnold Palmer Hospital for Children, Orlando, FL, USA
- Sara Singh, MBBS
- University of Guyana, School of Medicine, Georgetown, Guyana
- Yvette Loeffen, MD
- Division of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, Utrecht, Netherlands
- María Eulalia Tamayo Pérez, MD
- Coordinator of Neonatology Fellow Program, Head of Neonatal Intensive Care, University of Antioquia, Hospital San Vicente Fundacion, Medellin, Colombia
- Gloria Isabel Ferreyra, MD
- Department of Neonatology, Instituto de Maternidad Ntra. Sra. de las Mercedes, San Miguel de Tucumán, Argentina
- Victoria Lima-Rogel, MD
- Division of Neonatology, Hospital General Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico
- Barbara Perrone, MD
- Division of Neonatology and NICU, G. Salesi Children's Hospital, Ancona, Italy
- Giannina Izquierdo, MD
- Division of Neonatology and Pediatric Infectious Diseases, Hospital Barros Luco Trudeau, Santiago, Chile
- María Cernada, MD
- Division of Neonatology and Neonatal Research Group, La Fe University and Polytechnic Hospital, Valencia, Spain
- Sylvia Stoffella, PharmD
- Department of Pharmacy, UCSF Benioff Children's Hospital, San Francisco, CA, USA
- Sebastian Okwuchukwu Ekenze, MD
- Sub-Department of Pediatric Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
- Concepción de Alba-Romero, MD
- Division of Neonatology, Hospital 12 de Octubre, Madrid, Spain
- Chryssoula Tzialla, MD
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Jennifer T. Pham, PharmD
- Department of Pharmacy, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
- Kenichiro Hosoi, MD
- Department of Pediatrics, Kyorin University School of Medicine, Tokyo, Japan
- Magdalena Cecilia Calero Consuegra, MD
- Division of Neonatology, Hospital General San Francisco, Quito, Ecuador
- Pasqua Betta, MD
- Division of Neonatology and NICU, AOU Policlinico G Rodolico, Catania, Italy
- O. Alvaro Hoyos, MD
- Clínica Universitaria Bolivariana/Universidad Pontificia Bolivariana, Medellín, Colombia
- Emmanuel Roilides, MD
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Gabriela Naranjo-Zuñiga, MD
- Division of Pediatric Infectious Diseases, Hospital Nacional de Niños, San Jose, Costa Rica
- Makoto Oshiro, MD
- Department of Pediatrics, Nagoya Red Cross Daiichi Hospital, Nagoya, Japan
- Victor Garay, MD
- Division of Neonatology, Alberto Sabogal Hospital, Lima, Peru
- Vito Mondì, MD
- Policlinico Casilino, Rome, Italy
- Danila Mazzeo, MD
- Division of Patology and Intensive Neonatal Care, A.O.U. Policlinico di Messina, Messina, Italy
- James A. Stahl, PharmD
- Department of Pharmacy, Norton Children's Hospital, Louisville, KY, USA
- Joseph B. Cantey, MD
- Department of Pediatrics, Division of Neonatology, University Hospital UT Health San Antonio, San Antonio, TX
- Juan Gonzalo Mesa Monsalve, MD
- Pediatric Infectious Diseases, Hospital General de Medellín, Medellín, Colombia
- Erik Normann, MD
- Department of Women's and Children's Health, Uppsala University, Uppsala University Children's Hospital, Uppsala, Sweden
- Lindsay C. Landgrave, PharmD
- Department of Pharmacy, Parkview Regional Medical Center, Fort Wayne, IN, USA
- Ali Mazouri, MD
- Iran University of Medical Sciences, Tehran, Iran
- Claudia Alarcón Avila, MD
- Department of Perinatology and Neonatology, Central Military Hospital, Nueva Granada Military University, Bogotá, Colombia
- Fiammetta Piersigilli, MD
- Department of Neonatology, Cliniques Universitaires Saint Luc, Brussels, Belgium
- Monica Trujillo, MD
- Program Coordinator Pediatric Infectious Diseases Clinica Universiraria Bolivariana, Hospital Pablo Tobon Uribe, Medellin, Colombia
- Sonya Kolman, BPharm
- Department of Pharmacy, Nelson Mandela Children Hospital, Johannesburg, South Africa
- Verónica Delgado, MD
- Head of Neonatal Intensive Care, Hospital de los Valles, Quito, Ecuador
- Veronica Guzman, MD
- Pontificia Universidad Catolica del Ecuador, Hospital Metropolitano Quito, Quito, Ecuador
- Mohamed Abdellatif, FRCPCH
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
- Luis Monterrosa, MD
- Department of Pediatrics, Division of Neonatology, Saint John Regional Hospital, Saint John, Canada
- Lucia Gabriella Tina, MD
- Head of NICU Department, ARNAS Garibaldi, Catania, Italy
- Khalid Yunis, MD
- Division of Neonatology, American University of Beirut Medical Center, Beirut, Lebanon
- Marco Antonio Belzu Rodriguez, MD
- Division of Neonatology, Maternal and Children Hospital of Tigre Dr. Florencio Escardó, Tigre, Argentina
- Nicole Le Saux, MD
- Division of Infectious Disease, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada
- Valentina Leonardi, MD
- Division of Neonatology and NICU, Careggi Univerisity Hospital, Florence, Italy
- Alessandro Porta, MD
- G. Fornaroli Hospital, Magenta, Milan, Italy
- Giuseppe Latorre, MD
- Ospedale Miulli, Acquaviva, Italy
- Hidehiko Nakanishi, MD
- Research and Development Center for New Medical Frontiers, Department of Advanced Medicine, Division of Neonatal Intensive Care Medicine, Kitasato University School of Medicine, Sagamihara, Japan
- Michal Meir, MD
- Division of Pediatric Infectious Diseases, The Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Paolo Manzoni, MD
- Division of Pediatrics and Neonatology, Degli Infermi Hospital, Biella, Italy
- Ximena Norero, MD
- Hospital del Niño, Panama, Panama
- Angela Hoyos, MD
- Division of Neonatology, Clínica del Country / Clínica La Colina, Bogotá, Colombia
- Diana Arias, MD
- Hospital San Jose, Bogotá, Colombia
- Rubén García Sánchez, MD
- Hospital Universitario de Salamanca, Salamanca, Spain
- Alexandra K. Medoro, MD
- The Ohio State University College of Medicine, Columbus, OH, USA; Department of Pediatrics, Divisions of Neonatology and Pediatric Infectious Diseases, Nationwide Children's Hospital, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Pablo J. Sánchez
- The Ohio State University College of Medicine, Columbus, OH, USA; Department of Pediatrics, Divisions of Neonatology and Pediatric Infectious Diseases, Nationwide Children's Hospital, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Corresponding author at: Divisions of Neonatology and Pediatric Infectious Diseases, Nationwide Children's Hospital - The Ohio State University College of Medicine, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, RB3, WB5245, Columbus, Ohio 43205-2664, United States.
- Journal volume & issue
-
Vol. 32
p. 100727
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. Funding: Merck & Co.; The Ohio State University College of Medicine Barnes Medical Student Research Scholarship
