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

Angela Dramowski¹, Pavel Prusakov², Debra A Goff³, Adrian Brink⁴, Nelesh P Govender⁵, Ama Sakoa Annor⁶, Liezl Balfour⁷, Adrie Bekker⁸, Azraa Cassim⁹, Michelle Gijzelaar¹⁰, Sandi L Holgate⁸, Sonya Kolman¹¹, Angeliki Messina¹², Hafsah Tootla¹³, Natalie Schellack¹⁴, Andriette van Jaarsveld¹⁵, Kessendri Reddy¹⁶, Shakti Pillay¹⁷, Lucinda Conradie¹⁸, Anika M van Niekerk¹⁹, Tarina Bester²⁰, Pearl Alexander²¹, Antoinette Andrews²², Magdel Dippenaar²³, Colleen Bamford²⁴, Sharnel Brits²⁵, Pinky Chirwa²⁶, Hannelie Erasmus²³, Pieter Ekermans²⁷, Pebenita Gounden²⁸, Teresa Kriel²⁹, Dini Mawela³⁰, Masego Moncho³¹, Tonia Mphuthi⁹, Ronald Nhari³², Esmita Charani³³, Pablo J Sánchez³⁴, Dena van den Bergh³³; NeoAMS Study Team

Affiliations

¹ Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. Electronic address: dramowski@sun.ac.za.
² Merck & Co, Inc, Rahway, NJ, USA.
³ The Ohio State University College of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁴ Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa; National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
⁵ Division of the National Health Laboratory Service, National Institute for Communicable Diseases Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁶ Department of Pharmacy, Dr George Mukhari Academic Hospital, Pretoria, South Africa; Department of Clinical pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
⁷ Department of Nursing, Lenmed Group, Johannesburg, South Africa.
⁸ Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁹ Department of Pharmacy, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
¹⁰ Department of Pharmacy, Life Healthcare Group, Illovo, South Africa.
¹¹ Department of Pharmacy, Nelson Mandela Children's Hospital, Johannesburg, South Africa.
¹² Antimicrobial Stewardship Unit, Netcare Hospitals Ltd, Johannesburg, South Africa.
¹³ Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa; National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa.
¹⁴ Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
¹⁵ Department of Pharmacy Mediclinic Southern Africa, Stellenbosch, South Africa.
¹⁶ Division of Medical Microbiology and Immunology, Department of Pathology, Faculty of Medicine and Health Sciences, National Health Laboratory Service Tygerberg and Stellenbosch University, Cape Town, South Africa.
¹⁷ Division of Neonatology, Department of Paediatrics and Child Health, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
¹⁸ Pharmacy Department, Mowbray Maternity Hospital, Cape Town, South Africa.
¹⁹ Division of Neonatology, Department of Paediatrics and Child Health, Mowbray Maternity Hospital, University of Cape Town, Cape Town, South Africa.
²⁰ Netcare GNE Regional Clinical Pharmacy, Pretoria, South Africa.
²¹ Department of Nursing, Lenmed Royal Hospital & Heart Centre, Kimberley, South Africa.
²² Department of Nursing, Lenmed Ethekwini Hospital and Heart Centre, Durban, South Africa.
²³ Pharmacy Department, Mediclinic Welkom, Welkom, Free State, South Africa.
²⁴ Pathcare, East London, South Africa; Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
²⁵ Pharmacy Department, George Provincial Hospital, George, South Africa.
²⁶ Neonatal Unit, Nelson Mandela Childrens Hospital, Johannesburg, South Africa.
²⁷ Ampath Laboratory, National Reference Laboratory, Department of Medical Microbiology, Pretoria, South Africa.
²⁸ Department of Pharmacy, Lenmed Ethekwini Hospital and Heart Centre, Durban, South Africa.
²⁹ Pharmacy Department, Life Beacon Bay, East London, South Africa.
³⁰ Department of Paediatrics and Child Health, School of Medicine, Sefako Makgatho Health Sciences University, Gauteng, South Africa.
³¹ Department of Medical Microbiology-National Health Laboratory Services, Sefako Makgatho Health Sciences University, Gauteng, South Africa.
³² Department of Pharmacy, Life Springs Parkland Hospital, Johannesburg, South Africa.
³³ Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
³⁴ Department of Pediatrics, Divisions of Neonatology and Pediatric Infectious Diseases, Nationwide Children's Hospital, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.

PMID: 38945432
DOI: 10.1016/j.ijid.2024.107158

Free article

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

Angela Dramowski et al. Int J Infect Dis. 2024 Sep.

Free article

. 2024 Sep:146:107158.

doi: 10.1016/j.ijid.2024.107158. Epub 2024 Jun 28.

Authors

Affiliations

¹ Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. Electronic address: dramowski@sun.ac.za.
² Merck & Co, Inc, Rahway, NJ, USA.
³ The Ohio State University College of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁴ Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa; National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
⁵ Division of the National Health Laboratory Service, National Institute for Communicable Diseases Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁶ Department of Pharmacy, Dr George Mukhari Academic Hospital, Pretoria, South Africa; Department of Clinical pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
⁷ Department of Nursing, Lenmed Group, Johannesburg, South Africa.
⁸ Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁹ Department of Pharmacy, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
¹⁰ Department of Pharmacy, Life Healthcare Group, Illovo, South Africa.
¹¹ Department of Pharmacy, Nelson Mandela Children's Hospital, Johannesburg, South Africa.
¹² Antimicrobial Stewardship Unit, Netcare Hospitals Ltd, Johannesburg, South Africa.
¹³ Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa; National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa.
¹⁴ Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
¹⁵ Department of Pharmacy Mediclinic Southern Africa, Stellenbosch, South Africa.
¹⁶ Division of Medical Microbiology and Immunology, Department of Pathology, Faculty of Medicine and Health Sciences, National Health Laboratory Service Tygerberg and Stellenbosch University, Cape Town, South Africa.
¹⁷ Division of Neonatology, Department of Paediatrics and Child Health, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
¹⁸ Pharmacy Department, Mowbray Maternity Hospital, Cape Town, South Africa.
¹⁹ Division of Neonatology, Department of Paediatrics and Child Health, Mowbray Maternity Hospital, University of Cape Town, Cape Town, South Africa.
²⁰ Netcare GNE Regional Clinical Pharmacy, Pretoria, South Africa.
²¹ Department of Nursing, Lenmed Royal Hospital & Heart Centre, Kimberley, South Africa.
²² Department of Nursing, Lenmed Ethekwini Hospital and Heart Centre, Durban, South Africa.
²³ Pharmacy Department, Mediclinic Welkom, Welkom, Free State, South Africa.
²⁴ Pathcare, East London, South Africa; Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
²⁵ Pharmacy Department, George Provincial Hospital, George, South Africa.
²⁶ Neonatal Unit, Nelson Mandela Childrens Hospital, Johannesburg, South Africa.
²⁷ Ampath Laboratory, National Reference Laboratory, Department of Medical Microbiology, Pretoria, South Africa.
²⁸ Department of Pharmacy, Lenmed Ethekwini Hospital and Heart Centre, Durban, South Africa.
²⁹ Pharmacy Department, Life Beacon Bay, East London, South Africa.
³⁰ Department of Paediatrics and Child Health, School of Medicine, Sefako Makgatho Health Sciences University, Gauteng, South Africa.
³¹ Department of Medical Microbiology-National Health Laboratory Services, Sefako Makgatho Health Sciences University, Gauteng, South Africa.
³² Department of Pharmacy, Life Springs Parkland Hospital, Johannesburg, South Africa.
³³ Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
³⁴ Department of Pediatrics, Divisions of Neonatology and Pediatric Infectious Diseases, Nationwide Children's Hospital, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.

PMID: 38945432
DOI: 10.1016/j.ijid.2024.107158

Abstract

Background: Hospitalized neonates are vulnerable to infection and have high rates of antibiotic utilization.

Methods: 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.

Findings: 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).

Interpretation: 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.

Funding: A grant from Merck provided partial support.

Keywords: Africa; Antibiotic; Antimicrobial stewardship programme; Culture negative sepsis; Multi-disciplinary; Neonate; Pharmacist.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

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LinkOut - more resources

Full Text Sources