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

Manoj N. Malviya; Sathia Murthi; Ahmed A. Selim; Fadia Malik; Dhanya Jayraj; Julet Mendoza; Vidhya Ramdas; Sohail Rasheed; Amal Al Jabri; Raid al Sabri; Salima Al Asiry; Mohammed Al Yahmadi; Prakesh S. Shah

doi:10.1055/a-1933-0104

American Journal of Perinatology, Inhaltsverzeichnis

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

¹Department of Pediatrics, Khoula hospital, Muscat, Oman

,

Sathia Murthi

²Department of Statistics, OMSB, Muscat, Oman

,

Ahmed A. Selim

¹Department of Pediatrics, Khoula hospital, Muscat, Oman

,

Fadia Malik

¹Department of Pediatrics, Khoula hospital, Muscat, Oman

,

Dhanya Jayraj

¹Department of Pediatrics, Khoula hospital, Muscat, Oman

,

Julet Mendoza

¹Department of Pediatrics, Khoula hospital, Muscat, Oman

,

Vidhya Ramdas

¹Department of Pediatrics, Khoula hospital, Muscat, Oman

,

Sohail Rasheed

³Department of Information and Technology, Khoula hospital, Muscat, Oman

,

Amal Al Jabri

⁴Department of Microbiology, Khoula hospital, Muscat, Oman

,

Raid al Sabri

⁵Department of Pharmacy, Khoula hospital, Muscat, Oman

,

Salima Al Asiry

¹Department of Pediatrics, Khoula hospital, Muscat, Oman

,

Mohammed Al Yahmadi

¹Department of Pediatrics, Khoula hospital, Muscat, Oman

,

Prakesh S. Shah

⁶Department of Pediatrics, Mount Sinai hospital, Toronto, Canada

› Institutsangaben

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

Volltext

Referenzen

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