1. Prospective antimicrobial stewardship interventions by multidisciplinary teams to reduce neonatal antibiotic use in South Africa: The Neonatal Antimicrobial Stewardship (NeoAMS) study
- Author
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Angela Dramowski, Pavel Prusakov, Debra A. Goff, Adrian Brink, Nelesh P. Govender, Ama Sakoa Annor, Liezl Balfour, Adrie Bekker, Azraa Cassim, Michelle Gijzelaar, Sandi L. Holgate, Sonya Kolman, Angeliki Messina, Hafsah Tootla, Natalie Schellack, Andriette van Jaarsveld, Kessendri Reddy, Shakti Pillay, Lucinda Conradie, Anika M. van Niekerk, Tarina Bester, Pearl Alexander, Antoinette Andrews, Magdel Dippenaar, Colleen Bamford, Sharnel Brits, Pinky Chirwa, Hannelie Erasmus, Pieter Ekermans, Pebenita Gounden, Teresa Kriel, Dini Mawela, Masego Moncho, Tonia Mphuthi, Ronald Nhari, Esmita Charani, Pablo J. Sánchez, and Dena van den Bergh
- Subjects
Antibiotic ,Antimicrobial stewardship programme ,Neonate ,Africa ,Pharmacist ,Multi-disciplinary ,Infectious and parasitic diseases ,RC109-216 - 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.
- Published
- 2024
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