A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study
Creators: name: P Prusakov
name: DA Goff
name: PS Wozniak
name: A Cassim
name: CEA Scipion
name: S Urzúa
name: A Ronchi
name: L Zeng
name: O Ladipo-Ajayi
name: N Aviles-Otero
name: CR Udeigwe-Okeke
name: R Melamed
name: RC Silveira
name: C Auriti
name: C Beltrán-Arroyave
name: E Zamora-Flores
name: M Sanchez-Codez
name: ES Donkor
name: S Kekomäki
name: N Mainini
name: RV Trochez
name: J Casey
name: JM Graus
name: M Muller
name: S Singh
name: Y Loeffen
name: MET Pérez
name: GI Ferreyra
name: V Lima-Rogel
name: B Perrone
name: G Izquierdo
name: M Cernada
name: S Stoffella
name: SO Ekenze
name: C De Alba-Romero
name: C Tzialla
name: Pham, Jennifer
name: K Hosoi
name: MCC Consuegra
name: P Betta
name: OA Hoyos
name: E Roilides
name: G Naranjo-Zuñiga
name: M Oshiro
name: V Garay
name: V Mondì
name: D Mazzeo
name: JA Stahl
name: JB Cantey
name: JGM Monsalve
name: E Normann
name: LC Landgrave
name: A Mazouri
name: CA Avila
name: F Piersigilli
name: M Trujillo
name: S Kolman
name: V Delgado
name: V Guzman
name: M Abdellatif
name: L Monterrosa
name: LG Tina
name: K Yunis
name: MAB Rodriguez
name: NL Saux
name: V Leonardi
name: A Porta
name: G Latorre
name: H Nakanishi
name: M Meir
name: P Manzoni
name: X Norero
name: A Hoyos
name: D Arias
name: RG Sánchez
name: AK Medoro
name: PJ Sánchez
Publisher: name: University of Illinois at Chicago
Year: 2021
Subjects: Uncategorized

description: Background: Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. Methods: We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. Findings: On July 1, 2019, 26% of infants (580/2,265; range, 0–100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received ≥1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were “rule-out” sepsis (32%) and “culture-negative” sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and “culture-negative” infections was 12 days (median; IQR, 8–14) and 7 days (median; IQR, 5–10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0·02). Interpretation: Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide. Funding: Merck &amp; Co.; The Ohio State University College of Medicine Barnes Medical Student Research Scholarship