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

Prusakov, Pavel Goff, Debra A Wozniak, Phillip S Cassim, Azraa Scipion, Catherine E A Urzúa, Soledad Ronchi, Andrea Zeng, Lingkong Ladipo-Ajayi, Oluwaseun Aviles-Otero, Noelia Udeigwe-Okeke, Chisom R Melamed, Rimma Silveira, Rita C Auriti, Cinzia Beltrán-Arroyave, Claudia Zamora-Flores, Elena Sanchez-Codez, Maria Donkor, Eric S Kekomäki, Satu Mainini, Nicoletta Trochez, Rosalba Vivas Casey, Jamalyn Graus, Juan M Muller, Mallory Singh, Sara Loeffen, Yvette Pérez, María Eulalia Tamayo Ferreyra, Gloria Isabel Lima-Rogel, Victoria Perrone, Barbara Izquierdo, Giannina Cernada, María Stoffella, Sylvia Ekenze, Sebastian Okwuchukwu de Alba-Romero, Concepción Tzialla, Chryssoula Pham, Jennifer T Hosoi, Kenichiro Consuegra, Magdalena Cecilia Calero Betta, Pasqua Hoyos, O Alvaro Roilides, Emmanuel Naranjo-Zuñiga, Gabriela Oshiro, Makoto Garay, Victor Mondì, Vito Mazzeo, Danila Stahl, James A Cantey, Joseph B Monsalve, Juan Gonzalo Mesa Normann, Erik Landgrave, Lindsay C Mazouri, Ali Avila, Claudia Alarcón Piersigilli, Fiammetta [UCL] Trujillo, Monica Kolman, Sonya Delgado, Verónica Guzman, Veronica Abdellatif, Mohamed Monterrosa, Luis Tina, Lucia Gabriella Yunis, Khalid Rodriguez, Marco Antonio Belzu Saux, Nicole Le Leonardi, Valentina Porta, Alessandro Latorre, Giuseppe Nakanishi, Hidehiko Meir, Michal Manzoni, Paolo Norero, Ximena Hoyos, Angela Arias, Diana Sánchez, Rubén García Medoro, Alexandra K Sánchez, Pablo J Global NEO-ASP Study Group et al.[show all]

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.