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American Academy of Pediatrics
Article

Antimicrobial Stewardship in the NICU: Lessons We’ve Learned

Colleen Nash, Elisabeth Simmons, Palak Bhagat and Allison Bartlett
NeoReviews April 2014, 15 (4) e116-e122; DOI: https://doi.org/10.1542/neo.15-4-e116
Colleen Nash
*Fellow in Pediatric Infectious Diseases, Department of Pediatrics, Pritzker School of Medicine, University of Chicago, Chicago, IL.
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Elisabeth Simmons
†Clinical pharmacist, Department of Pharmacy, Comer Children’s Hospital, Neonatal Intensive Care Unit, University of Chicago, Chicago, IL.
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Palak Bhagat
‡Clinical pharmacist, Department of Pharmacy, Comer Children’s Hospital, Antimicrobial Stewardship Program, University of Chicago, Chicago, IL.
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Allison Bartlett
§Assistant Professor of Pediatrics, Associate Medical Director, Infection Control Program, Associate Medical Director, Antimicrobial Stewardship Program, Pritzker School of Medicine, University of Chicago, Chicago, IL.
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  • Abbreviations:
    ASP,
    antimicrobial stewardship program
    CDC,
    Centers for Disease Control and Prevention
    CLABSI,
    central line–associated bloodstream infection
    CVC,
    central venous catheter
    ELBW,
    extremely low birthweight
    EOS,
    early-onset sepsis
    IDSA,
    Infectious Diseases Society of America
    LOS,
    late-onset sepsis
    MRSA,
    methicillin-resistant Staphylococcus aureus
    NEC,
    necrotizing enterocolitis
    PICC,
    peripherally inserted central catheter
    VLBW,
    very low birthweight
  • Abstract

    The neonatal intensive care unit (NICU) presents a unique challenge within hospitals. A neonate’s response to an infectious insult is challenging to differentiate from other pathologic processes, thereby making antimicrobial management more difficult. Antimicrobial stewardship programming has sought to combat this difficulty, relying on its core principles of appropriate antimicrobial selection, dose, duration, and route of administration. Increasing evidence suggests that imprudent and prolonged use of antimicrobials can lead to various undesirable health outcomes for neonates, including necrotizing enterocolitis, disseminated fungal infection, and even death. The need for empiric antimicrobial use is unavoidable, but there are ways in which concomitant antimicrobial stewardship and infection prevention efforts can allow for optimal clinical outcomes. Pharmacy-driven stewardship efforts of optimal neonatal dosing and therapeutic drug-level management of patients in our institution’s NICU serve as examples of NICU-specific stewardship initiatives. These types of stewardship efforts function as part of a larger effort to create a culture of conscientious and judicious antimicrobial use within our NICU.

    • Copyright © 2014 by the American Academy of Pediatrics

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    NeoReviews
    Vol. 15, Issue 4
    1 Apr 2014
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    Antimicrobial Stewardship in the NICU: Lessons We’ve Learned
    Colleen Nash, Elisabeth Simmons, Palak Bhagat, Allison Bartlett
    NeoReviews Apr 2014, 15 (4) e116-e122; DOI: 10.1542/neo.15-4-e116

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    Antimicrobial Stewardship in the NICU: Lessons We’ve Learned
    Colleen Nash, Elisabeth Simmons, Palak Bhagat, Allison Bartlett
    NeoReviews Apr 2014, 15 (4) e116-e122; DOI: 10.1542/neo.15-4-e116
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    • Article
      • Abstract
      • Educational Gaps
      • Objectives
      • Introduction
      • Definitions and Background
      • Stewardship in the NICU
      • Reducing the Need for Antibiotics
      • Limiting Antibiotic Duration
      • Maximizing Safety and Efficacy
      • Conclusions
      • Footnotes
      • References
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