Antimicrobial Prophylaxis Use in the Neonatal Intensive Care Unit: An Antimicrobial Stewardship Target That Deserves Attention!

Abstract

Objective Previous analyses of neonatal intensive care units (NICU) antimicrobial stewardship programs have identified key contributors to overall antibiotic use, including prolonged empiric therapy >48 hours for early-onset sepsis (EOS). However, most were performed in mixed NICU settings with onsite birthing units, resulting in a high proportion of inborn patient admissions. The study aimed to describe and analyze the most common reasons for antimicrobial use in an outborn tertiary care NICU.

Study Design This was a 10-month review of all antimicrobial doses prescribed in a 20-bed level III NICU. The primary outcome was the total days of therapy (DOT) and length of therapy (LOT) for each clinical indication. Secondary outcomes included total DOT for each antimicrobial and appropriateness of antimicrobial courses.

Results Of 235 antibiotic courses and 1,899 DOT (519 DOT/1,000 patient days) prescribed in 173 infants during the study period, the most common indications were suspected EOS, followed by prophylaxis. Among the 85 DOT/1,000 patient days (PD; 38 courses) prescribed for prophylaxis, 52.5 DOT/1,000 PD (25 courses; 62%) were for surgical prophylaxis. Of 17 postoperative antibiotic courses, 15 (88.2%) were deemed to be inappropriate mostly due to a duration greater than 24 hours postoperatively (n = 13; median LOT = 3 days).

Conclusion Surgical prophylaxis is a common reason for antimicrobial misuse in outborn NICU. NICU-based prospective audit and feedback between neonatologists and antimicrobial stewardship teams alone may not be impactful in this setting. Partnerships with neonatologists and surgeons will be key to achieving the target of less than 24 hours of postoperative antimicrobials.

Key Points

• Surgical prophylaxis is a common reason for antimicrobial misuse in the NICU.

• Antimicrobial prophylaxis duration of less than 24 hours postoperatively should be encouraged.

• NICU-based prospective audit and feedback may not be impactful unless surgeons are involved.

Keywords

antimicrobial stewardship - NICU - surgical prophylaxis

Note

The institutional research ethic board waived the need to review.

Authors' Contributions

I.V.T., A.A., E.B., N.L.S., and N.T. have participated to the conception of this brief report. I.V.T. drafted the initial version. Subsequently, all of the co-authors revised the manuscript. All authors approved the final version of the review. I.V.T. is the corresponding author, and as such has full access to the data and final responsibility for the decision to submit for publication.

Publication History

Received: 06 July 2020

Accepted: 02 December 2020

Article published online:
17 January 2021

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