A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study

Prusakov, P. and Goff, D.A. and Wozniak, P.S. and Cassim, A. and Scipion, C.E.A. and Urzúa, S. and Ronchi, A. and Zeng, L. and Ladipo-Ajayi, O. and Aviles-Otero, N. and Udeigwe-Okeke, C.R. and Melamed, R. and Silveira, R.C. and Auriti, C. and Beltrán-Arroyave, C. and Zamora-Flores, E. and Sanchez-Codez, M. and Donkor, E.S. and Kekomäki, S. and Mainini, N. and Trochez, R.V. and Casey, J. and Graus, J.M. and Muller, M. and Singh, S. and Loeffen, Y. and Pérez, M.E.T. and Ferreyra, G.I. and Lima-Rogel, V. and Perrone, B. and Izquierdo, G. and Cernada, M. and Stoffella, S. and Ekenze, S.O. and de Alba-Romero, C. and Tzialla, C. and Pham, J.T. and Hosoi, K. and Consuegra, M.C.C. and Betta, P. and Hoyos, O.A. and Roilides, E. and Naranjo-Zuñiga, G. and Oshiro, M. and Garay, V. and Mondì, V. and Mazzeo, D. and Stahl, J.A. and Cantey, J.B. and Monsalve, J.G.M. and Normann, E. and Landgrave, L.C. and Mazouri, A. and Avila, C.A. and Piersigilli, F. and Trujillo, M. and Kolman, S. and Delgado, V. and Guzman, V. and Abdellatif, M. and Monterrosa, L. and Tina, L.G. and Yunis, K. and Rodriguez, M.A.B. and Saux, N.L. and Leonardi, V. and Porta, A. and Latorre, G. and Nakanishi, H. and Meir, M. and Manzoni, P. and Norero, X. and Hoyos, A. and Arias, D. and Sánchez, R.G. and Medoro, A.K. and Sánchez, P.J. and for the Global NEO-ASP Study Group, and Giuseppe Latorre, m.d and Alessandro Porta, m.d and Valentina Leonardi, m.d (2021) A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study. EClinicalMedicine, 32.

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Abstract

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 & Co.; The Ohio State University College of Medicine Barnes Medical Student Research Scholarship © 2021 The Authors

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