International Journal of Infectious Diseases (Sep 2024)
Prospective antimicrobial stewardship interventions by multidisciplinary teams to reduce neonatal antibiotic use in South Africa: The Neonatal Antimicrobial Stewardship (NeoAMS) study
- Angela Dramowski,
- Pavel Prusakov,
- Debra A. Goff,
- Adrian Brink,
- Nelesh P. Govender,
- Ama Sakoa Annor,
- Liezl Balfour,
- Adrie Bekker,
- Azraa Cassim,
- Michelle Gijzelaar,
- Sandi L. Holgate,
- Sonya Kolman,
- Angeliki Messina,
- Hafsah Tootla,
- Natalie Schellack,
- Andriette van Jaarsveld,
- Kessendri Reddy,
- Shakti Pillay,
- Lucinda Conradie,
- Anika M. van Niekerk,
- Tarina Bester,
- Pearl Alexander,
- Antoinette Andrews,
- Magdel Dippenaar,
- Colleen Bamford,
- Sharnel Brits,
- Pinky Chirwa,
- Hannelie Erasmus,
- Pieter Ekermans,
- Pebenita Gounden,
- Teresa Kriel,
- Dini Mawela,
- Masego Moncho,
- Tonia Mphuthi,
- Ronald Nhari,
- Esmita Charani,
- Pablo J. Sánchez,
- Dena van den Bergh
Affiliations
- Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Corresponding author.
- Pavel Prusakov
- Merck & Co, Inc, Rahway, NJ, USA
- Debra A. Goff
- The Ohio State University College of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Adrian Brink
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa; National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Nelesh P. Govender
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Ama Sakoa Annor
- Department of Pharmacy, Dr George Mukhari Academic Hospital, Pretoria, South Africa; Department of Clinical pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Liezl Balfour
- Department of Nursing, Lenmed Group, Johannesburg, South Africa
- Adrie Bekker
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Azraa Cassim
- Department of Pharmacy, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
- Michelle Gijzelaar
- Department of Pharmacy, Life Healthcare Group, Illovo, South Africa
- Sandi L. Holgate
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Sonya Kolman
- Department of Pharmacy, Nelson Mandela Children's Hospital, Johannesburg, South Africa
- Angeliki Messina
- Antimicrobial Stewardship Unit, Netcare Hospitals Ltd, Johannesburg, South Africa
- Hafsah Tootla
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa; National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa
- Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Andriette van Jaarsveld
- Department of Pharmacy Mediclinic Southern Africa, Stellenbosch, South Africa
- Kessendri Reddy
- Division of Medical Microbiology and Immunology, Department of Pathology, Faculty of Medicine and Health Sciences, National Health Laboratory Service Tygerberg and Stellenbosch University, Cape Town, South Africa
- Shakti Pillay
- Division of Neonatology, Department of Paediatrics and Child Health, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Lucinda Conradie
- Pharmacy Department, Mowbray Maternity Hospital, Cape Town, South Africa
- Anika M. van Niekerk
- Division of Neonatology, Department of Paediatrics and Child Health, Mowbray Maternity Hospital, University of Cape Town, Cape Town, South Africa
- Tarina Bester
- Netcare GNE Regional Clinical Pharmacy, Pretoria, South Africa
- Pearl Alexander
- Department of Nursing, Lenmed Royal Hospital & Heart Centre, Kimberley, South Africa
- Antoinette Andrews
- Department of Nursing, Lenmed Ethekwini Hospital and Heart Centre, Durban, South Africa
- Magdel Dippenaar
- Pharmacy Department, Mediclinic Welkom, Welkom, Free State, South Africa
- Colleen Bamford
- Pathcare, East London, South Africa; Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Sharnel Brits
- Pharmacy Department, George Provincial Hospital, George, South Africa
- Pinky Chirwa
- Neonatal Unit, Nelson Mandela Childrens Hospital, Johannesburg, South Africa
- Hannelie Erasmus
- Pharmacy Department, Mediclinic Welkom, Welkom, Free State, South Africa
- Pieter Ekermans
- Ampath Laboratory, National Reference Laboratory, Department of Medical Microbiology, Pretoria, South Africa
- Pebenita Gounden
- Department of Pharmacy, Lenmed Ethekwini Hospital and Heart Centre, Durban, South Africa
- Teresa Kriel
- Pharmacy Department, Life Beacon Bay, East London, South Africa
- Dini Mawela
- Department of Paediatrics and Child Health, School of Medicine, Sefako Makgatho Health Sciences University, Gauteng, South Africa
- Masego Moncho
- Department of Medical Microbiology-National Health Laboratory Services, Sefako Makgatho Health Sciences University, Gauteng, South Africa
- Tonia Mphuthi
- Department of Pharmacy, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
- Ronald Nhari
- Department of Pharmacy, Life Springs Parkland Hospital, Johannesburg, South Africa
- Esmita Charani
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Pablo J. Sánchez
- 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, The Ohio State University College of Medicine, Columbus, OH, USA
- Dena van den Bergh
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Journal volume & issue
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Vol. 146
p. 107158
Abstract
Background: Hospitalized neonates are vulnerable to infection and have high rates of antibiotic utilization. Methods: Fourteen South African neonatal units (seven public, seven private sector) assembled multidisciplinary teams involving neonatologists, microbiologists, pharmacists, and nurses to implement prospective audit and feedback neonatal antimicrobial stewardship (NeoAMS) interventions. The teams attended seven online training sessions. Pharmacists conducted weekday antibiotic prescription reviews in the neonatal intensive care unit and/or neonatal wards providing feedback to the clinical teams. Anonymized demographic and NeoAMS interventions data were aggregated for descriptive purposes and statistical analysis. Findings: During the 20-week NeoAMS intervention in 2022, 565 neonates were enrolled. Pharmacists evaluated seven hundred antibiotic prescription episodes; rule-out sepsis (180; 26%) and culture-negative sepsis (138; 20%) were the most frequent indications for antibiotic prescription. For infection episodes with an identified pathogen, only 51% (116/229) of empiric treatments provided adequate antimicrobial coverage. Pharmacists recommended 437 NeoAMS interventions (0·6 per antibiotic prescription episode), with antibiotic discontinuation (42%), therapeutic drug monitoring (17%), and dosing (15%) recommendations most frequent. Neonatal clinicians’ acceptance rates for AMS recommendations were high (338; 77%). Mean antibiotic length of therapy decreased by 24% from 9·1 to 6·9 days (0·1 day decrease per intervention week; P = 0·001), with the greatest decline in length of therapy for culture-negative sepsis (8·2 days (95% CI 5·7-11·7) to 5·9 days (95% CI 4·6-7·5); P = 0·032). Interpretation: This neonatal AMS programme was successfully implemented in heterogenous and resource-limited settings. Pharmacist-recommended AMS interventions had high rates of clinician acceptance. The NeoAMS intervention significantly reduced neonatal antibiotic use, particularly for culture-negative sepsis. Funding: A grant from Merck provided partial support.
