Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years

Antimicrobial Stewardship Programs as a Means to Optimize Antimicrobial Use

Each year, approximately 2 million people in the United States contract an infection during a hospital stay. An increasing percentage of these institutionally acquired infections are attributed to antimicrobial-resistant organisms. At the same time, studies and surveys suggest that as much as half of all antimicrobial use is inappropriate. Recommendations for preventing and reducing antimicrobial resistance in hospitals stress the importance of improving antimicrobial use, referred to as antimicrobial stewardship, at the institutional level. Antimicrobial stewardship programs have served as wake-up calls to both clinicians and health care administrators. We review the more recent literature concerning the impact of antimicrobial stewardship programs on costs, outcomes, and resistance and summarize important considerations for implementation of these programs.

Late-onset infection and the role of antibiotic prescribing policies

PURPOSE OF REVIEW

Late-onset infection is a significant cause of morbidity and mortality in low-birth-weight and premature infants. Empirical antibiotic treatment is used as infants can deteriorate rapidly without treatment. Current data on the epidemiology of late-onset infection, the types of antibiotics used, duration of antibiotic use, and antibiotic prescribing policies are reviewed.

RECENT FINDINGS

Epidemiological data on late-onset sepsis is dominated by information concerning developed countries; large prospective data collections have been set up in many such countries. Recent data indicate that late-onset sepsis occurs in one-fifth of very-low-birth-weight infants. There are increasing concerns regarding antibiotic resistance. Antibiotic regimens that do not include third-generation cephalosporins produce less resistance. Strategies of antibiotic rotation have not been documented as producing a marked effect on the development of resistant micro-organisms, but there is a lack of randomized trials. Recommendations for preventing the spread of vancomycin-resistant enterococci, produced by the Hospital Infection Control Practices Advisory Committee, have been shown to be effective in a number of situations. Recent reports have documented the success of multidisciplinary, systems-orientated approaches for reducing neonatal nosocomial infection.

SUMMARY

Antibiotic prescribing policies have an important role to play in the treatment of late-onset neonatal infection. There is enough evidence to state that narrow-spectrum antibiotics should be used wherever possible and that potent broad-spectrum antibiotics should be kept in reserve. Ongoing prospective surveillance of infection rates, micro-organisms, resistance and antibiotic use is essential.