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