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. 2021 Jan 29:32:100727.
doi: 10.1016/j.eclinm.2021.100727. eCollection 2021 Feb.

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

Pavel Prusakov  1 , Debra A Goff  2 , Phillip S Wozniak  3 , Azraa Cassim  4 , Catherine E A Scipion  5 , Soledad Urzúa  6 , Andrea Ronchi  7 , Lingkong Zeng  8 , Oluwaseun Ladipo-Ajayi  9 , Noelia Aviles-Otero  10 , Chisom R Udeigwe-Okeke  11 , Rimma Melamed  12 , Rita C Silveira  13 , Cinzia Auriti  14 , Claudia Beltrán-Arroyave  15 , Elena Zamora-Flores  16 , Maria Sanchez-Codez  17 , Eric S Donkor  18 , Satu Kekomäki  19 , Nicoletta Mainini  20 , Rosalba Vivas Trochez  21 , Jamalyn Casey  22 , Juan M Graus  23 , Mallory Muller  24 , Sara Singh  25 , Yvette Loeffen  26 , María Eulalia Tamayo Pérez  27 , Gloria Isabel Ferreyra  28 , Victoria Lima-Rogel  29 , Barbara Perrone  30 , Giannina Izquierdo  31 , María Cernada  32 , Sylvia Stoffella  33 , Sebastian Okwuchukwu Ekenze  34 , Concepción de Alba-Romero  35 , Chryssoula Tzialla  36 , Jennifer T Pham  37 , Kenichiro Hosoi  38 , Magdalena Cecilia Calero Consuegra  39 , Pasqua Betta  40 , O Alvaro Hoyos  41 , Emmanuel Roilides  42 , Gabriela Naranjo-Zuñiga  43 , Makoto Oshiro  44 , Victor Garay  45 , Vito Mondì  46 , Danila Mazzeo  47 , James A Stahl  48 , Joseph B Cantey  49 , Juan Gonzalo Mesa Monsalve  50 , Erik Normann  51 , Lindsay C Landgrave  52 , Ali Mazouri  53 , Claudia Alarcón Avila  54 , Fiammetta Piersigilli  55 , Monica Trujillo  56 , Sonya Kolman  57 , Verónica Delgado  58 , Veronica Guzman  59 , Mohamed Abdellatif  60 , Luis Monterrosa  61 , Lucia Gabriella Tina  62 , Khalid Yunis  63 , Marco Antonio Belzu Rodriguez  64 , Nicole Le Saux  65 , Valentina Leonardi  66 , Alessandro Porta  67 , Giuseppe Latorre  68 , Hidehiko Nakanishi  69 , Michal Meir  70 , Paolo Manzoni  71 , Ximena Norero  72 , Angela Hoyos  73 , Diana Arias  74 , Rubén García Sánchez  75 , Alexandra K Medoro  3   76 , Pablo J Sánchez  3   76 ; Global NEO-ASP Study Group
Affiliations

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

Pavel Prusakov et al. EClinicalMedicine. .

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.

Keywords: Antibiotics; Antifungal; Global point prevalence study; Neonatal antimicrobial stewardship; Neonatal infection.

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Conflict of interest statement

Dr. Pablo J. Sánchez has received research grant support from Merck & Co. during the conduct of the study, and grant from MedImmune, Inc - AstraZeneca, outside of the submitted work. Dr. Pavel Prusakov has received research grant support from Merck & Co. and Pfizer. Dr. Debra A. Goff has received research grant support from Merck & Co. and Pfizer. Dr. Landgrave reports other support from GSK, outside the submitted work. Dr. Kekomäki reports grants and personal fees from Sanofi, grants and personal fees from Merck Sharp & Dome, other support from Pfizer, all outside of the submitted work. Dr. Mesa reports speaker fees from Pfizer and GlaxoSmithKline, outside of the submitted work. Mr. Wozniak received a Barnes Medical Student Research Scholarship grant from The Ohio State University College of Medicine. The other authors have nothing to disclose.

Figures

Fig 1
Fig. 1
Map of the 29 countries that participated in the NO-More-AntibioticS and Resistance (NO-MAS-R) study, a point prevalence study of all infants in the neonatal intensive care unit (NICU) who received at least one antimicrobial agent on July 1, 2019, the birthday of Ignaz Semmelweiss, MD. Participating countries (number of NICUs; total number of infants on antimicrobial therapy) by level of income were: High income, Belgium (n = 1; 3), Canada (n = 2; 5), Chile (n = 4; 38), Finland (n = 1; 10), Greece (n = 1; 5), Israel (n = 2; 14), Italy (n = 13; 77), Japan (n = 3; 12), Netherlands (n = 1; 9), Oman (n = 1; 3), Panama (n = 1; 1), Spain (n = 5; 35), Sweden (n = 1; 4), United States (n = 15; 84); Middle-to-Low Income, Argentina (n = 2; 10), Brazil (n = 1; 13), China (n = 1; 21), Colombia (n = 12; 43), Costa Rica (n = 1; 5), Ecuador (n = 3; 12), Ghana (n = 1; 10), Guyana (n = 1; 9), Haiti (n = 1; 29), Iran (n = 1; 3), Lebanon (n = 1; 2), Mexico (n = 1; 8), Nigeria (n = 3; 43), Peru (n = 2; 14), South Africa (n = 2; 58).
Fig 2
Fig. 2
Indications for antibiotic use among the 531 infants, with the percentage of infants who received antibacterial therapy for that indication on the x-axis.
Fig 3
Fig. 3
Percentage of total antibiotic use among infants in the neonatal intensive care unit as determined by the World Health Organization AWaRe classification* by a) global region and b) AWaRe group. *AWaRe = Access, Watch, and Reserve.
See this image and copyright information in PMC

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