Prospective antimicrobial stewardship interventions by multidisciplinary teams to reduce neonatal antibiotic use in South Africa: The Neonatal Antimicrobial Stewardship (NeoAMS) study

•First multi-site, multi-disciplinary neonatal stewardship study on the African continent.•Multidisciplinary teams reduced antibiotic length of therapy in neonates by 24%.•Pharmacist antibiotic recommendations had 77% neonatal clinician acceptance.•The greatest decline in length of therapy was for c...

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Published in:	International journal of infectious diseases Vol. 146; p. 107158
Main Authors:	Dramowski, Angela, Prusakov, Pavel, Goff, Debra A., Brink, Adrian, Govender, Nelesh P., Annor, Ama Sakoa, Balfour, Liezl, Bekker, Adrie, Cassim, Azraa, Gijzelaar, Michelle, Holgate, Sandi L., Kolman, Sonya, Messina, Angeliki, Tootla, Hafsah, Schellack, Natalie, van Jaarsveld, Andriette, Reddy, Kessendri, Pillay, Shakti, Conradie, Lucinda, van Niekerk, Anika M., Bester, Tarina, Alexander, Pearl, Andrews, Antoinette, Dippenaar, Magdel, Bamford, Colleen, Brits, Sharnel, Chirwa, Pinky, Erasmus, Hannelie, Ekermans, Pieter, Gounden, Pebenita, Kriel, Teresa, Mawela, Dini, Moncho, Masego, Mphuthi, Tonia, Nhari, Ronald, Charani, Esmita, Sánchez, Pablo J., Bergh, Dena van den
Format:	Journal Article
Language:	English
Published:	Canada Elsevier Ltd 01-09-2024 Elsevier
Subjects:	Africa Antibiotic Antimicrobial stewardship programme Culture negative sepsis Multi-disciplinary Neonate Pharmacist CRP AMR FBC Africa AMS NICU IQR NEC EONS LOT Antibiotic Neonate NNU Antimicrobial stewardship programme LMIC BSI Pharmacist Multi-disciplinary TDM Culture negative sepsis
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Summary:	•First multi-site, multi-disciplinary neonatal stewardship study on the African continent.•Multidisciplinary teams reduced antibiotic length of therapy in neonates by 24%.•Pharmacist antibiotic recommendations had 77% neonatal clinician acceptance.•The greatest decline in length of therapy was for culture negative sepsis.•Collaboration led to successful neonatal stewardship in resource limited settings. Hospitalized neonates are vulnerable to infection and have high rates of antibiotic utilization. Fourteen South African neonatal units (seven public, seven private sector) assembled multidisciplinary teams involving neonatologists, microbiologists, pharmacists, and nurses to implement prospective audit and feedback neonatal antimicrobial stewardship (NeoAMS) interventions. The teams attended seven online training sessions. Pharmacists conducted weekday antibiotic prescription reviews in the neonatal intensive care unit and/or neonatal wards providing feedback to the clinical teams. Anonymized demographic and NeoAMS interventions data were aggregated for descriptive purposes and statistical analysis. During the 20-week NeoAMS intervention in 2022, 565 neonates were enrolled. Pharmacists evaluated seven hundred antibiotic prescription episodes; rule-out sepsis (180; 26%) and culture-negative sepsis (138; 20%) were the most frequent indications for antibiotic prescription. For infection episodes with an identified pathogen, only 51% (116/229) of empiric treatments provided adequate antimicrobial coverage. Pharmacists recommended 437 NeoAMS interventions (0·6 per antibiotic prescription episode), with antibiotic discontinuation (42%), therapeutic drug monitoring (17%), and dosing (15%) recommendations most frequent. Neonatal clinicians’ acceptance rates for AMS recommendations were high (338; 77%). Mean antibiotic length of therapy decreased by 24% from 9·1 to 6·9 days (0·1 day decrease per intervention week; P = 0·001), with the greatest decline in length of therapy for culture-negative sepsis (8·2 days (95% CI 5·7-11·7) to 5·9 days (95% CI 4·6-7·5); P = 0·032). This neonatal AMS programme was successfully implemented in heterogenous and resource-limited settings. Pharmacist-recommended AMS interventions had high rates of clinician acceptance. The NeoAMS intervention significantly reduced neonatal antibiotic use, particularly for culture-negative sepsis. A grant from Merck provided partial support. [Display omitted]
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1201-9712 1878-3511 1878-3511
DOI:	10.1016/j.ijid.2024.107158