Antibiotic stewardship - Clinical Tree

Key points

Antibiotics are lifesaving and improve outcomes in neonatal clinical care.
Increasing evidence in animal and human models links antibiotic exposure with alterations in the microbiome, the developing immune system, and subsequent effects on health.
Empiric antibiotic use is linked to the emergence of infections caused by multidrug-resistant organisms and to increased risk of necrotizing enterocolitis and mortality.
The primary goal of antibiotic stewardship programs in neonatal intensive care units is to reduce morbidity and save lives by appropriate use of antibiotics in the treatment of proven and suspected neonatal infections. A secondary goal is to reduce healthcare costs.
Implementation of multidisciplinary antibiotic stewardship strategy may slow emergence of antibiotic resistant organisms and lead to other improved outcomes including shorter hospitalizations, and fewer adverse drug events.

Neonatologists prescribe antibiotics more than any other medication. ^, Because of the risk for development of antibiotic-resistant organisms, adverse drug events that may result from antibiotic exposure, the emerging evidence that antibiotics influence the developing microbiome in both term and preterm infants, and association studies linking antibiotic exposures to subsequent systemic disease, neonatologists and other stakeholders have heeded guidance from experts and more recently from more authoritative sources, such as the Centers for Disease Control and Prevention (CDC), to become better stewards of antibiotic use in the neonatal intensive care unit (NICU). Notable improvements have been associated with participation in large-scale, multicenter antibiotic stewardship efforts. This chapter reviews early and more recent efforts to optimize antibiotic use in the NICU and highlights areas for ongoing stewardship efforts.

Antibiotic stewardship programs: We were warned

In an address to the American Association of Penicillin Producers more than 70 years ago, Alexander Fleming, the discoverer of penicillin, cautioned clinicians regarding overuse of penicillin and the emergence of organisms resistant to penicillin. Approximately 40 years and dozens of approved antimicrobial compounds later, Harold Neu, a leader in infectious disease research who developed the inhibitory quotient, which reflects antimicrobial effectiveness in different tissue compartments, warned of complacency regarding antibiotic use and predicted that the emergence of resistant organisms was likely to occur in community hospitals. He recommended that “antibiotic control programs, better hygiene, and improved antimicrobial activity must be adopted to limit emergence of resistance.”

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here