Antimicrobial Stewardship in the NICU

• Published in: Infectious disease clinics of North America Vol. 28; no. 2; pp. 247 - 261
• Main Authors: Cantey, Joseph B., MD, Patel, Sameer J., MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2014
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotic Prophylaxis - standards; Antimicrobial; Bacterial Infections - drug therapy; Clinical Protocols - standards; Drug Resistance, Microbial; Humans; Inappropriate Prescribing - prevention & control; Infectious Disease; Intensive Care Units, Neonatal; Medication Therapy Management - standards; Metrics; Neonatal intensive care unit; Neonatology - methods; Sepsis - drug therapy; Stewardship; Antimicrobial; Stewardship; Metrics; Neonatal intensive care unit
• ISSN: 0891-5520; 1557-9824
• DOI: 10.1016/j.idc.2014.01.005

There are unique challenges to antimicrobial stewardship in neonatal intensive care units (NICUs). Diagnosis of infection is difficult as neonates can have nonspecific signs and symptoms. Between and within NICUs, significant variation exists in the treatment duration of suspected sepsis and pneumonia. Development of multidisciplinary teams and meaningful metrics are essential for sustainable antibiotic stewardship. Potential stewardship interventions include optimizing culturing techniques, guiding empiric therapy by NICU-specific antibiograms, using ancillary laboratory tests, and promptly discontinuing therapy once infection is no longer suspected. Use of large neonatal databases can be used to benchmark antibiotic use and conduct comparative effectiveness research.