Table 1

Antimicrobial stewardship programme in neonatal settings: a systematic review (January 2000–April 2019)

AuthorsStudy designSettingCity, country, study periodAimsInterventionsSummary of key findings
Chiu et al12NCITSTwo tertiary NICUs; 50 and 18 bedsBoston, USA;
2005 to 2008		To evaluate effectiveness and safety of a guideline restricting vancomycin use

  • Introduction of an electronic guideline restricting vancomycin use

  • Change of vancomycin use from 6.9/1000 PD to 4.5/PD in hospital 1 (p=0.01), and from 17/1000 PD to 6.4/1000 PD in Hospital 2 (p<0.0001)

  • Change of infants exposed to vancomycin from 5.2/1000 PD to 3.1/1000 PD (p=0.008) in hospital 1, and from 10.8/1000 PD to 5.5/1000 PD in hospital 2 (p=0.009)

Ting et al16NCBASingle NICUVancouver, Canada; 2010 to 2015To evaluate the effectiveness of ASP on antibiotic prescription practices

  • Audit and feedback

  • Revision of antibiotic guideline

  • Education on judicious antimicrobial use

  • New technology to reduce time of microbiological diagnosis

  • Change of inappropriate meropenem antibiotic—days from 1.89 to 1.96 (RR (95% CI): 1.04 (0.70–1.52)) per 1000 DOT

  • Change of inappropriate cefotaxime antibiotic—days from 3.56 to 1.73 (RR (95% CI): 0.49 (0.33–0.71)) per 1000 DOT

  • Change of inappropriate vancomycin antibiotic—days from 2.70 to 1.01 (RR (95% CI): 0.37 (0.22–0.60)) per 1000 DOT

  • No improvement of inappropriate antibiotic prescriptions in very low birthweight infants

  • No changes in inappropriate courses of linezolid

Nzegwu et al13NCITSSingle level IV NICU; 54 bedsBoston, USA;
2011–2016		To evaluate an ASP on prescription practices

  • Development of clinical guidelines on the treatment of common neonatal infections

  • Audit and feedback by a multidisciplinary ASP team

  • Education on judicious antibiotic use

  • Change of monthly antibiotic use from 270.4 to 258.8 DOT/1000 PD (p=0.669)

  • Change of monthly ampicillin use from 118.6 to 103.4 DOT/1000 PD (p=0.037)

  • No significant changes of vancomycin, cefotaxime and gentamicin/tobramycin

  • Decrease of late-onset sepsis evaluation and prescription events per 100 NICU days (p<0.0001), with an average reduction of 2.65 evaluations per year per provider Clinical guidelines adherence of 98.75%

Lee et al14NCITSSingle paediatric centre, NICU; 60 bedsMemphis, USA;
2010 to 2013		To evaluate the effectiveness of a new guideline about antimicrobial use for common infections and early-onset sepsis on antimicrobial use

  • Development of a guideline taking into account local antibiograms

  • Education on judicious antimicrobial use

  • Regular audits and feedback

  • Change of antibiotic use from 448 to 367 DOT/1000 PD

  • Change of targeted broad-spectrum antibiotics from 70 to 27 DOT/1000 PD

Mc Carthy et al17NCBASingle NICU; 50 bedsCork, Ireland; September 2016 to March 2017To evaluate the effectiveness of a local guideline in combination with audits and electronic prescribing on antimicrobial use

  • Development of a local guideline on antibiotic prescription

  • Education on judicious antimicrobial use

  • Electronic prescribing

  • Audit and feedback

  • Multidisciplinary round

  • Change of antibiotic use from 572 to 417 DOT/1000 PD (p<0.0001)

  • Change of prolonged antibiotic use (>36 hours) from 82 to 7.5 DOT/1000 PD (p=0.0004)

  • Change of prolonged antibiotic use (>5 days) from 46.5 to 7 DOT/1000 PD (p=0.0009)

Cantey et al15NCITSSingle level 3C NICU; 90 bedsTexas, USA; March 2012 to June 2014To inform ASP strategies in a NICU, determining areas where antibiotic use could be reduced safety

  • Extension of ruled-out sepsis courses beyond 48 hours

  • Treatment duration for culture-negative pneumonia

  • Treatment duration for culture-negative sepsis

  • Change of antibiotic use from 343.2 to 252.2 DOT/1000 PD (p<0.0001)

  • Change of 48 hours rule-out courses (percentage discontinued <48 hours) from 32% to 95% (p<0.0001)

  • Change of infants with culture-negative sepsis treated <5 days from 31% to 62% (p=0.04)

  • Change of pneumonia treatments<5 days from 36% to 72% (p<0.0001)

  • ASP, antimicrobial stewardship program; DOT, days of therapy; NCBA, non-controlled before-and-afterstudy; NCC, non-controlled cohort study; NCITS, non-controlled time-series analysis; NICU, neonatal intensive care unit; PD, patient-day.