Abstract：
BACKGROUND: Hospitalised neonates are vulnerable to infection and have high rates of antibiotic utilisation.
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. Anonymised demographic and NeoAMS interventions data were aggregated for descriptive purposes and statistical analysis.
RESULTS: 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).
CONCLUSIONS: 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.
BACKGROUND: A grant from Merck provided partial support.
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. Anonymised demographic and NeoAMS interventions data were aggregated for descriptive purposes and statistical analysis.
RESULTS: 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).
CONCLUSIONS: 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.
BACKGROUND: A grant from Merck provided partial support.
摘要：
背景：住院新生儿易受感染，抗生素使用率高。
方法：十四个南非新生儿病房（七个公共，七个私营部门)组建了涉及新生儿学家的多学科小组，微生物学家,药剂师,和护士实施前瞻性审核和反馈新生儿抗菌药物管理（NeoAMS）干预措施。这些团队参加了七个在线培训课程。药剂师在新生儿重症监护病房和/或新生儿病房进行了平日的抗生素处方审查，向临床团队提供反馈。出于描述性目的和统计分析的目的，对匿名的人口统计学和NeoAMS干预数据进行了汇总。
结果：在2022年进行的为期20周的NeoAMS干预期间，纳入了565名新生儿。药剂师评估了700次抗生素处方发作；排除败血症（180;26％）和培养阴性败血症（138;20％）是抗生素处方的最常见适应症。对于已确定病原体的感染事件，只有51%(116/229)的经验性治疗提供了足够的抗菌药物覆盖率.药剂师推荐437个NeoAMS干预措施（每个抗生素处方发作0·6），抗生素停药（42%），治疗药物监测(17%)，和给药（15％）建议最频繁。新生儿临床医生对AMS建议的接受率很高（338；77%）。从9·1到6·9天，平均抗生素治疗时间减少了24％（每个干预周减少0·1天；p=0·001），培养阴性脓毒症的治疗时间缩短最大(8·2天(95CI5·7-11·7)至5·9天(95%CI4·6-7·5);p=0·032)。
结论：这项新生儿AMS计划在异质和资源有限的环境中成功实施。药剂师推荐的AMS干预措施对临床医生的接受率很高。NeoAMS干预显着减少了新生儿抗生素的使用，特别是培养阴性脓毒症。
背景：默克公司的一项资助提供了部分支持。
方法：十四个南非新生儿病房（七个公共，七个私营部门)组建了涉及新生儿学家的多学科小组，微生物学家,药剂师,和护士实施前瞻性审核和反馈新生儿抗菌药物管理（NeoAMS）干预措施。这些团队参加了七个在线培训课程。药剂师在新生儿重症监护病房和/或新生儿病房进行了平日的抗生素处方审查，向临床团队提供反馈。出于描述性目的和统计分析的目的，对匿名的人口统计学和NeoAMS干预数据进行了汇总。
结果：在2022年进行的为期20周的NeoAMS干预期间，纳入了565名新生儿。药剂师评估了700次抗生素处方发作；排除败血症（180;26％）和培养阴性败血症（138;20％）是抗生素处方的最常见适应症。对于已确定病原体的感染事件，只有51%(116/229)的经验性治疗提供了足够的抗菌药物覆盖率.药剂师推荐437个NeoAMS干预措施（每个抗生素处方发作0·6），抗生素停药（42%），治疗药物监测(17%)，和给药（15％）建议最频繁。新生儿临床医生对AMS建议的接受率很高（338；77%）。从9·1到6·9天，平均抗生素治疗时间减少了24％（每个干预周减少0·1天；p=0·001），培养阴性脓毒症的治疗时间缩短最大(8·2天(95CI5·7-11·7)至5·9天(95%CI4·6-7·5);p=0·032)。
结论：这项新生儿AMS计划在异质和资源有限的环境中成功实施。药剂师推荐的AMS干预措施对临床医生的接受率很高。NeoAMS干预显着减少了新生儿抗生素的使用，特别是培养阴性脓毒症。
背景：默克公司的一项资助提供了部分支持。
