Abstract
Antimicrobial prescriptions in neonatal intensive care units (NICUs) represent a point
of concern for the emergence of MDROs and for morbidity associated with prolonged
antibiotic exposure (e.g., invasive candidiasis, necrotizing enterocolitis, and late-onset
sepsis). Antimicrobial stewardship programs (ASPs) have shown to be a valuable tool
for the prevention of resistance with the goals of optimizing clinical outcomes while
decreasing unnecessary prescribing. The most frequent ASP strategies include the correct
collection and interpretation of microbiological specimens, prescription of the narrowest-spectrum
antibiotic appropriate for a particular case, and de-escalation or discontinuation
of therapy in defined situations. A robust ASP requires everyday multidisciplinary
collaboration between ID physicians, neonatologist, clinical pharmacists, clinical
microbiologists, infection control professionals, hospital epidemiologists, and information
services specialists. Education and clinical pathways (e.g., sepsis or surgical prophylaxis
pathways) are an excellent starting point if followed by proactive interventions such
as prospective audits and feedback and formulary restriction with prior antimicrobial
authorization. The current review outlines the problems faced in NICU antimicrobial
prescribing and presents various solutions from the literature.
Keywords
antibiotics - neonatal intensive care unit - antimicrobial stewardship
