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Stewardship / Resistance Scan for Sep 21, 2021

Stewardship / Resistance Scan for Sep 21, 2021

Canadian study finds high antimicrobial use in preterm infants

A study of preterm newborns in Canada found high rates of antimicrobial use in the first 7 days after birth, researchers reported last week in Infection Control & Hospital Epidemiology.

Using data from the Canadian Neonatal Network, which covers 90% of neonatal intensive care unit (NICU) admissions in Canada, the researchers analyzed antimicrobial use in infants born earlier than 33 weeks gestational age (GA) to determine the proportion of preterm infants without culture-proven early-onset sepsis (EOS) or necrotizing enterocolitis (NEC) who received one or more antimicrobials during the first 7 days after birth. They also explored the variability in antimicrobial use between sites in different GA subgroups.

Out of 31,295 infants from 30 sites, 27,163 (85%) did not develop EOS or NEC ≥ stage 2 during their hospitalization and were included in the analysis. Among those infants, 44% born at 26 weeks or earlier, 21% born from 27 to 29 weeks, and 10% born from 30 to 32 weeks GA received an antimicrobial on day 7 of life. Those proportions dropped to 29%, 10%, and 4%, respectively, by day 14.

The site-level median antibiotic use rate values for those without EOS and/or NEC ≥ stage 2 were 0.15 for infants born at 26 weeks or earlier, 0.11 for infants born from 27 to 29 weeks, and 0.12 for infants born from 30 to 32 weeks GA, with significant variability across the individual sites in each GA group. This intersite variability persisted for infants in all three GA groups after adjusting for confounding variables.

The study authors note that although antimicrobials are the most commonly prescribed medication in NICUs and are administered shortly after birth to most preterm infants due to increased risk of infection, excessive antimicrobial exposure in newborns without EOS is associated with increased morbidity, mortality, and/or neurodevelopmental impairment. They say the findings suggest that decreasing antimicrobial exposure in preterm infants without infections could be an important antimicrobial stewardship program (ASP) target.

“Reduction of high rates of antimicrobial use at early postnatal age, particularly among lower GA infants at very low risk of developing EOS by applying 36- or 48-hour automatic stop order and regular audit and feedback can be important ASP strategies,” they wrote. “Standardizing and auditing the practice by developing nationwide NICU-specific ASP may help reduce interfacility variability in the long run.” 
Sep 17 Infect Control Hosp Epidemiol abstract


Trial: Probiotic doesn’t prevent ventilator-associated pneumonia

A randomized trial conducted among critically ill patients found that the probiotic Lactobacillus rhamnosus GG did not prevent ventilator-associated pneumonia (VAP) or other infections, researchers reported today in JAMA.

Conducted in 44 intensive care units (ICUs) in the United States, Canada, and Saudi Arabia, the trial enrolled critically ill adults predicted to require mechanical ventilation and randomly assigned them to receive L rhamnosus GG or a placebo twice daily.

Previous randomized trials have indicated that probiotics can reduce infection rates in critically ill patients by 20% and may decrease the risk of VAP by 25% to 30%, perhaps through enhanced gut barrier function, competitive inhibition of pathogenic bacteria, and modulation of the host inflammatory response. Investigators wanted to see if this particular strain might have a similar benefit.

The primary outcome was VAP. Secondary outcomes included other ICU-acquired infections (including Clostridioides difficile infection), diarrhea, antimicrobial use, ICU and hospital length of stay, and mortality.

Of the patients included in the analysis, 1,318 received L rhamnosus GG, and 1,332 received a placebo for a median of 9 days. VAP developed in 289 of the 1,318 patients (21.9%) who received probiotics, compared with 284 of 1,332 (21.3%) in the placebo group (hazard ratio, 1.03; 95% confidence interval [CI], 0.87 to 1.22; absolute difference, 0.6%).

No significant differences were found between the two groups for any of the secondary outcomes. Fifteen patients who received probiotics (1.1%) experienced an adverse event, compared with only 1 (0.1%) in the placebo group (odds ratio, 14.02; 95% CI, 1.79 to 109.6).    

“These findings do not support the use of L rhamnosus GG for prevention of ventilator-associated pneumonia or other clinically important outcomes in critically ill patients,” the study authors concluded.
Sep 21 JAMA abstract

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