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Am J Perinatol 2024; 41(S 01): e747-e754
DOI: 10.1055/a-1933-0104
Original Manuscript

A Neonatologist-Driven Antimicrobial Stewardship Program in a Neonatal Tertiary Care Center in Oman

Manoj N. Malviya
1   Department of Pediatrics, Khoula hospital, Muscat, Oman
,
Sathia Murthi
2   Department of Statistics, OMSB, Muscat, Oman
,
Ahmed A. Selim
1   Department of Pediatrics, Khoula hospital, Muscat, Oman
,
Fadia Malik
1   Department of Pediatrics, Khoula hospital, Muscat, Oman
,
Dhanya Jayraj
1   Department of Pediatrics, Khoula hospital, Muscat, Oman
,
Julet Mendoza
1   Department of Pediatrics, Khoula hospital, Muscat, Oman
,
Vidhya Ramdas
1   Department of Pediatrics, Khoula hospital, Muscat, Oman
,
Sohail Rasheed
3   Department of Information and Technology, Khoula hospital, Muscat, Oman
,
Amal Al Jabri
4   Department of Microbiology, Khoula hospital, Muscat, Oman
,
Raid al Sabri
5   Department of Pharmacy, Khoula hospital, Muscat, Oman
,
Salima Al Asiry
1   Department of Pediatrics, Khoula hospital, Muscat, Oman
,
Mohammed Al Yahmadi
1   Department of Pediatrics, Khoula hospital, Muscat, Oman
,
Prakesh S. Shah
6   Department of Pediatrics, Mount Sinai hospital, Toronto, Canada
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Abstract

Objective The overuse of antimicrobials in neonates is not uncommon and has resulted in a global health crisis of antibiotic resistance. This study aimed to evaluate changes associated with a neonatologist-driven antimicrobial stewardship program (ASP) in antibiotic usage.

Study Design We conducted a pre–post retrospective cohort study in a tertiary care hospital in Oman. Neonates admitted in 2014 to 2015 were considered as the pre-ASP cohort. In 2016, a neonatologist-driven ASP was launched in the unit. The program included the optimization and standardization of antibiotic use for early- and late-onset sepsis using the Centers for Disease Control and Prevention's “broad principles,” an advanced antimicrobial decision-support system to resolve contentious issues, and placed greater emphasis on education and behavior modification. Data from the years 2016 to 2019 were compared with previous data. The outcome of interest included days of therapy (DOT) for antimicrobials. Baseline characteristics and outcomes were compared using standard statistical measures.

Results The study included 2,098 neonates in the pre-ASP period and 5,464 neonates in the post-ASP period. There was no difference in baseline characteristics. The antibiotic use decreased from 752 DOT per 1,000 patient-days (PD) in the pre-ASP period to 264 DOT in the post-ASP period (64.8% reduction, p < 0.001). The proportion of neonates who received any antibiotics declined by 46% (pre-ASP = 1,161/2,098, post-ASP = 1,676/5,464). The most statistically significant reduction in DOT per 1,000 PD was observed in the use of cefotaxime (82%), meropenem (74%), and piperacillin–tazobactam (74%). There was no change in mortality, culture-positive microbial profile, or multidrug-resistant organism incidence in the post-ASP period.

Conclusion Empowering frontline neonatologists to drive ASPs was associated with a sustained reduction in antibiotic utilization.

Key Points

  • Overuse of antimicrobials is not uncommon in neonatal intensive care units.

  • ASPs and infection control and prevention measures may help in decreasing antibiotic consumption and culture-positive sepsis.

  • Empowering frontline neonatologists resulted in a sustained decrease in antimicrobial use without extra resources or financial burden.

Keywords

antimicrobial stewardship program - antibiotics - NICU - neonatal intensive care - neonatologist-driven


Publication History

Received: 14 January 2022

Accepted: 17 August 2022

Accepted Manuscript online:
29 August 2022

Article published online:
19 October 2022

© 2022. Thieme. All rights reserved.

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