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

Author

Prusakov, Pavel, Goff, Debra A., Wozniak, Phillip S., Cassim, Azraa, Scipion, Catherine E.A., Urzúa, Soledad, Ronchi, Andrea, Zeng, Lingkong, Ladipo-Ajayi, Oluwaseun, Aviles-Otero, Noelia, Udeigwe-Okeke, Chisom R., Melamed, Rimma, Silveira, Rita C., Auriti, Cinzia, Beltrán-Arroyave, Claudia, Zamora-Flores, Elena, Sanchez-Codez, Maria, Donkor, Eric S., Kekomäki, Satu, Mainini, Nicoletta, Trochez, Rosalba Vivas, Casey, Jamalyn, Graus, Juan M., Muller, Mallory, Singh, Sara, Loeffen, Yvette, Pérez, María Eulalia Tamayo, Ferreyra, Gloria Isabel, Lima-Rogel, Victoria, Perrone, Barbara, Izquierdo, Giannina, Cernada, María, Stoffella, Sylvia, Ekenze, Sebastian Okwuchukwu, de Alba-Romero, Concepción, Tzialla, Chryssoula, Pham, Jennifer T., Hosoi, Kenichiro, Consuegra, Magdalena Cecilia Calero, Betta, Pasqua, Hoyos, O. Alvaro, Roilides, Emmanuel, Naranjo-Zuñiga, Gabriela, Oshiro, Makoto, Garay, Victor, Mondì, Vito, Mazzeo, Danila, Stahl, James A., Cantey, Joseph B., Monsalve, Juan Gonzalo Mesa, Normann, Erik, Landgrave, Lindsay C., Mazouri, Ali, Avila, Claudia Alarcón, Piersigilli, Fiammetta, Trujillo, Monica, Kolman, Sonya, Delgado, Verónica, Guzman, Veronica, Abdellatif, Mohamed, Monterrosa, Luis, Tina, Lucia Gabriella, Yunis, Khalid, Rodriguez, Marco Antonio Belzu, Saux, Nicole Le, Leonardi, Valentina, Porta, Alessandro, Latorre, Giuseppe, Nakanishi, Hidehiko, Meir, Michal, Manzoni, Paolo, Norero, Ximena, Hoyos, Angela, Arias, Diana, Sánchez, Rubén García, Medoro, Alexandra K., and Sánchez, Pablo J.

Published
2021
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13. A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study.

Author

UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service de néonatologie, Prusakov, Pavel, Goff, Debra A, Wozniak, Phillip S, Cassim, Azraa, Scipion, Catherine E A, Urzúa, Soledad, Ronchi, Andrea, Zeng, Lingkong, Ladipo-Ajayi, Oluwaseun, Aviles-Otero, Noelia, Udeigwe-Okeke, Chisom R, Melamed, Rimma, Silveira, Rita C, Auriti, Cinzia, Beltrán-Arroyave, Claudia, Zamora-Flores, Elena, Sanchez-Codez, Maria, Donkor, Eric S, Kekomäki, Satu, Mainini, Nicoletta, Trochez, Rosalba Vivas, Casey, Jamalyn, Graus, Juan M, Muller, Mallory, Singh, Sara, Loeffen, Yvette, Pérez, María Eulalia Tamayo, Ferreyra, Gloria Isabel, Lima-Rogel, Victoria, Perrone, Barbara, Izquierdo, Giannina, Cernada, María, Stoffella, Sylvia, Ekenze, Sebastian Okwuchukwu, de Alba-Romero, Concepción, Tzialla, Chryssoula, Pham, Jennifer T, Hosoi, Kenichiro, Consuegra, Magdalena Cecilia Calero, Betta, Pasqua, Hoyos, O Alvaro, Roilides, Emmanuel, Naranjo-Zuñiga, Gabriela, Oshiro, Makoto, Garay, Victor, Mondì, Vito, Mazzeo, Danila, Stahl, James A, Cantey, Joseph B, Monsalve, Juan Gonzalo Mesa, Normann, Erik, Landgrave, Lindsay C, Mazouri, Ali, Avila, Claudia Alarcón, Piersigilli, Fiammetta, Trujillo, Monica, Kolman, Sonya, Delgado, Verónica, Guzman, Veronica, Abdellatif, Mohamed, Monterrosa, Luis, Tina, Lucia Gabriella, Yunis, Khalid, Rodriguez, Marco Antonio Belzu, Saux, Nicole Le, Leonardi, Valentina, Porta, Alessandro, Latorre, Giuseppe, Nakanishi, Hidehiko, Meir, Michal, Manzoni, Paolo, Norero, Ximena, Hoyos, Angela, Arias, Diana, Sánchez, Rubén García, Medoro, Alexandra K, Sánchez, Pablo J, Global NEO-ASP Study Group, UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service de néonatologie, Prusakov, Pavel, Goff, Debra A, Wozniak, Phillip S, Cassim, Azraa, Scipion, Catherine E A, Urzúa, Soledad, Ronchi, Andrea, Zeng, Lingkong, Ladipo-Ajayi, Oluwaseun, Aviles-Otero, Noelia, Udeigwe-Okeke, Chisom R, Melamed, Rimma, Silveira, Rita C, Auriti, Cinzia, Beltrán-Arroyave, Claudia, Zamora-Flores, Elena, Sanchez-Codez, Maria, Donkor, Eric S, Kekomäki, Satu, Mainini, Nicoletta, Trochez, Rosalba Vivas, Casey, Jamalyn, Graus, Juan M, Muller, Mallory, Singh, Sara, Loeffen, Yvette, Pérez, María Eulalia Tamayo, Ferreyra, Gloria Isabel, Lima-Rogel, Victoria, Perrone, Barbara, Izquierdo, Giannina, Cernada, María, Stoffella, Sylvia, Ekenze, Sebastian Okwuchukwu, de Alba-Romero, Concepción, Tzialla, Chryssoula, Pham, Jennifer T, Hosoi, Kenichiro, Consuegra, Magdalena Cecilia Calero, Betta, Pasqua, Hoyos, O Alvaro, Roilides, Emmanuel, Naranjo-Zuñiga, Gabriela, Oshiro, Makoto, Garay, Victor, Mondì, Vito, Mazzeo, Danila, Stahl, James A, Cantey, Joseph B, Monsalve, Juan Gonzalo Mesa, Normann, Erik, Landgrave, Lindsay C, Mazouri, Ali, Avila, Claudia Alarcón, Piersigilli, Fiammetta, Trujillo, Monica, Kolman, Sonya, Delgado, Verónica, Guzman, Veronica, Abdellatif, Mohamed, Monterrosa, Luis, Tina, Lucia Gabriella, Yunis, Khalid, Rodriguez, Marco Antonio Belzu, Saux, Nicole Le, Leonardi, Valentina, Porta, Alessandro, Latorre, Giuseppe, Nakanishi, Hidehiko, Meir, Michal, Manzoni, Paolo, Norero, Ximena, Hoyos, Angela, Arias, Diana, Sánchez, Rubén García, Medoro, Alexandra K, Sánchez, Pablo J, and Global NEO-ASP Study Group

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.

Published
2021

14. Clinical challenges to the concept of ectogestation

Author

Wozniak, Phillip S

Abstract

Since the publication of the successful animal trials of the Biobag, a prototypical extrauterine support for extremely premature neonates, numerous ethicists have debated the potential implications of such a device. Some have argued that the Biobag represents a natural evolution of traditional newborn intensive care, while others believe that the Biobag would create a new class of being for the patients housed within. Kingma and Finn argued in Bioethicsfor making a categorical distinction between fetuses, newborns and ‘gestatelings’ in a Biobag on the basis of a conceptual distinction between ectogenesis versus ectogestation. Applying their arguments to the clinical realities of newborn intensive care, however, demonstrates the inapplicability of their ideas to the practice of medicine. Here, I present three clinical examples of the difficulty and confusion their argument would create for clinicians and offer a possible remedy: namely, discarding the term ‘artificial womb’ in favour of ‘Biobag’.

Published
2023
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