Pragmatic Expansion of a Neonatal Antibiotic Stewardship Program in a Community Health Care System

Applying quality improvement methods to reduce antibiotic use in neonates: a systematic review and meta-analysis

BACKGROUND

This study aims to explore effective interventions and observation indicators for reducing antibiotic use in neonates through quality improvement (QI) methods, while quantitatively analysing whether these methods increase the risk of neonatal mortality and serious adverse outcomes.

METHODS

By 27 August 2024, we reviewed all pertinent literature. A descriptive statistical analysis was conducted on all intervention measures, outcome indicators, process indicators, and balance indicators. The group utilizing QI interventions was designated as the intervention group, with the baseline period serving as the control group. The mortality rates and incidence of serious adverse outcomes were treated as dichotomous variables. The risk ratio (RR) and 95% CIs were effect indicators.

RESULTS

In total, 57 studies published between 2016 and 2024 were included. All studies were uncontrolled before-and-after studies. The most studied country was the United States of America. From these 57 studies, 27 effective intervention measures were identified, and all observation indicators and main results were presented in tabular form. According to the meta-analysis, the mortality rate in the intervention group decreased by 30% compared with the control group (RR = 0.7; 95% CI: 0.604-0.81; P < 0.001), while there was no statistically significant difference in the risk of serious adverse outcomes between the two groups.

CONCLUSIONS

QI methods can safely and effectively reduce the use of antibiotics in neonates, highlighting their potential for clinical applications.

Promoting real-world evidence use for antimicrobial stewardship in Latin America: evaluation of impact of a two-part educational webinar series

Background

Educational programs on the use of real-world evidence (RWE) in antimicrobial stewardship (AMS) are scarce in Latin America (LATAM).

Objectives

To develop and evaluate an online educational program supporting LATAM healthcare professionals (HCP)'s ability to use and generate RWE for effective antimicrobial agent use, aligned with AMS principles.

Methods

Two 90-min webinars were developed by subject matter experts. Changes in knowledge, skills, confidence and attitudes were measured via paired PRE-and POST-intervention survey questions. Satisfaction, intent to change and remaining barriers were surveyed POST-intervention. McNemar and Wilcoxon Signed Rank statistical tests assessed differences in paired dichotomous and ordinal data, respectively. Unpaired data underwent descriptive analysis. Open-ended responses were subject to thematic content analysis (inductive reasoning approach).

Results

The analysis sample included 741 PRE-intervention survey completers (epidemiologists, infection control specialists, chemists, pharmacists, biologists, microbiologists, bacteriologists and other physicians), with 47 completing the full POST survey (33 following webinar 1, and 14 following webinar 2). A significant increase in the percent of completers who were confident of 'what constitutes RWE' was found PRE (31%) to POST (73%) intervention (P < 0.001). Median self-reported skill levels changed from '2-basic' to '3-intermediate' for providing examples of RWE and applying RWE in the context of AMS (P < 0.05). Barriers included low perceived value of RWE by administrators and limited access to appropriate data.

Conclusions

This education improved HCPs' confidence in knowing what constitutes RWE. Findings provide direction for future interventions aimed at enhancing access to and appropriate use of RWE to inform AMS in LATAM.

Neonatal Necrotizing Enterocolitis: An Update on Pathophysiology, Treatment, and Prevention

Necrotizing enterocolitis (NEC) is a life-threatening disease predominantly affecting premature and very low birth weight infants resulting in inflammation and necrosis of the small bowel and colon and potentially leading to sepsis, peritonitis, perforation, and death. Numerous research efforts have been made to better understand, treat, and prevent NEC. This review explores a variety of factors involved in the pathogenesis of NEC (prematurity, low birth weight, lack of human breast milk exposure, alterations to the microbiota, maternal and environmental factors, and intestinal ischemia) and reports treatment modalities surrounding NEC, including pain medications and common antibiotic combinations, the rationale for these combinations, and recent antibiotic stewardship approaches surrounding NEC treatment. This review also highlights the effect of early antibiotic exposure, infections, proton pump inhibitors (PPIs), and H2 receptor antagonists on the microbiota and how these risk factors can increase the chances of NEC. Finally, modern prevention strategies including the use of human breast milk and standardized feeding regimens are discussed, as well as promising new preventative and treatment options for NEC including probiotics and stem cell therapy.

Antimicrobial Stewardship in Pediatrics

Since the discovery of antibiotics in the early 20th century, significant changes have occurred in their usage principles [...].