Abstract Antibiotics are commonly used in the neonatal intensive care unit (NICU), but unnecessary or long-time exposure to antibiotics early after birth can increase the risk of poor prognosis of neonates. Antibiotic treatment in the NICU often begins with empiric therapy, but no uniform standards have been established for the initiation and course of empiric therapy. In neonates with negative bacterial culture Results and stable clinical manifestations, empiric antibiotic therapy should be terminated in a timely manner. There are significant differences in the use of antibiotics in different NICUs. A targeted antimicrobial stewardship program is an effective way for optimizing the use of antibiotics in the NICU.
Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities:an updated systematic analysis[J]. Lancet, 2015, 385(9966):430-440.
[2]
Cantey JB, Wozniak PS, Sánchez PJ. Prospective surveillance of antibiotic use in the neonatal intensive care unit:results from the SCOUT study[J]. Pediatr Infect Dis J, 2015, 34(3):267-272.
[3]
Lee JH, Hornik CP, Benjamin DK Jr, et al. Risk factors for invasive candidiasis in infants >1500 g birth weight[J]. Pediatr Infect Dis J, 2013, 32(3):222-226.
[4]
Kuppala VS, Meinzen-Derr J, Morrow AL, et al. Prolonged initial empirical antibiotic treatment is associated with adverse outcomes in premature infants[J]. J Pediatr, 2011, 159(5):720-725.
[5]
Ting JY, Synnes A, Roberts A, et al. Association between antibiotic use and neonatal mortality and morbidities in very low-birth-weight infants without culture-proven sepsis or necrotizing enterocolitis[J]. JAMA Pediatr, 2016, 170(12):1181-1187.
[6]
Cantey JB, Huffman LW, Subramanian A, et al. Antibiotic exposure and risk for death or bronchopulmonary dysplasia in very low birth weight infants[J]. J Pediatr, 2017, 181:289-293. e1.
[7]
Lapin B, Piorkowski J, Ownby D, et al. The relationship of early-life antibiotic use with asthma in at-risk children[J]. J Allergy Clin Immunol, 2014, 134(3):728-729.
[8]
Saari A, Virta LJ, Sankilampi U, et al. Antibiotic exposure in infancy and risk of being overweight in the first 24 months of life[J]. Pediatrics, 2015, 135(4):617-626.
[9]
Stoll BJ, Hansen NI, Sánchez PJ, et al. Early onset neonatal sepsis:the burden of group B Streptococcal and E. coli disease continues[J]. Pediatrics, 2011, 127(5):817-826.
[10]
Schrag SJ, Farley MM, Petit S, et al. Epidemiology of invasive early-onset neonatal sepsis, 2005 to 2014[J]. Pediatrics, 2016, 138(6):e20162013.
[11]
Fjalstad JW, Stensvold HJ, Bergseng H, et al. Early-onset sepsis and antibiotic exposure in term infants:a nationwide populationbased study in norway[J]. Pediatr Infect Dis J, 2016, 35(1):1-6.
[12]
Waters D, Jawad I, Ahmad A, et al. Aetiology of communityacquired neonatal sepsis in low and middle income countries[J]. J Glob Health, 2011, 1(2):154-170.
[13]
Hamer DH, Darmstadt GL, Carlin JB, et al. Etiology of bacteremia in young infants in six countries[J]. Pediatr Infect Dis J, 2015, 34(1):e1-e8.
Shah J, Jeffries AL, Yoon EW, et al. Risk factors and outcomes of late onset bacterial sepsis in preterm neonates born at <32 weeks gestation[J]. Am J Perinatol, 2015, 32(7):675-682.
[16]
Downie L, Armiento R, Subhi R, et al. Community-acquired neonatal and infant sepsis in developing countries:efficacy of WHO's currently recommended antibiotics-systematic review and meta-analysis[J]. Arch Dis Child, 2013, 98(2):146-154.
[17]
Putignani L, Del Chierico F, Petrucca A, et al. The human gut microbiota:a dynamic interplay with the host from birth to senescence settled during childhood[J]. Pediatr Res, 2014, 76(1):2-10.
[18]
Cox LM, Yamanishi S, Sohn J, et al. Altering the intestinal microbiota during a critical developmental window has lasting metabolic consequences[J]. Cell, 2014, 158(4):705-721.
[19]
Giuffrè M, Geraci DM, Bonura C, et al. The increasing challenge of multidrug-resistant gram-negative bacilli:results of a 5-year active surveillance program in a neonatal intensive care unit[J]. Medicine (Baltimore), 2016, 95(10):e3016.
[20]
Tsai MH, Chu SM, Hsu JF, et al. Risk factors and outcomes for multidrug-resistant Gram-negative bacteremia in the NICU[J]. Pediatrics, 2014, 133(2):e322-e329.
[21]
Polin RA; Committee on Fetus and Newborn. Management of neonates with suspected or proven early-onset bacterial sepsis[J]. Pediatrics, 2012, 129(5):1006-1015.
[22]
Caffrey Osvald E, Prentice P. NICE clinical guideline:antibiotics for the prevention and treatment of early-onset neonatal infection[J]. Arch Dis Child Educ Pract Ed, 2014, 99(3):98-100.
[23]
Cantey JB. Optimizing the use of antibacterial agents in the neonatal period[J]. Paediatr Drugs, 2016, 18(2):109-122.
[24]
Heideking M, Lander F, Hufnagel M, et al. Antibiotic susceptibility profiles of neonatal invasive isolates of Escherichia coli from a 2-year nationwide surveillance study in Germany, 2009-2010[J]. Eur J Clin Microbiol Infect Dis, 2013, 32(9):1221-1223.
[25]
Ericson JE, Thaden J, Cross HR, et al. No survival benefit with empirical vancomycin therapy for coagulase-negative staphylococcal bloodstream infections in infants[J]. Pediatr Infect Dis J, 2015, 34(4):371-375.
[26]
WHO Guidelines Approved by the Guidelines Review Committee. Pocket book of hospital care for children:guidelines for the management of common childhood illnesses[M]. 2nd edition. Geneva:World Health Organization, 2013:51-54.
[27]
Al-Taiar A, Hammoud MS, Cuiqing L, et al. Neonatal infections in China, Malaysia, Hong Kong and Thailand[J]. Arch Dis Child Fetal Neonatal Ed, 2013, 98(3):F249-F255.
[28]
Downie L, Armiento R, Subhi R, et al. Community-acquired neonatal and infant sepsis in developing countries:efficacy of WHO's currently recommended antibiotics-systematic review and meta-analysis[J]. Arch Dis Child, 2013, 98(2):146-154.
[29]
van Herk W, el Helou S, Janota J, et al. Variation in current management of term and late-preterm neonates at risk for earlyonset sepsis:an international survey and review of guidelines[J]. Pediatr Infect Dis J, 2016, 35(5):494-500.
[30]
Verani JR, McGee L, Schrag SJ, et al. Prevention of perinatal group B streptococcal disease-revised guidelines from CDC, 2010[J]. MMWR Recomm Rep, 2010, 59(RR-10):1-36.
[31]
Cotten CM. Antibiotic stewardship:reassessment of guidelines for management of neonatal sepsis[J]. Clin Perinatol, 2015, 42(1):195-206.
[32]
Benitz WE, Wynn JL, Polin RA. Reappraisal of guidelines for management of neonates with suspected early-onset sepsis[J]. J Pediatr, 2015, 166(4):1070-1074.
[33]
Higgins RD, Saade G, Polin RA, et al. Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis:summary of a workshop[J]. Obstet Gynecol, 2016, 127(3):426-436.
[34]
Escobar GJ, Puopolo KM, Wi S, et al. Stratification of risk of early-onset sepsis in newborns ≥ 34 weeks' gestation pediatrics[J]. 2014, 133(1):30-36.
[35]
Kuzniewicz MW, Puopolo KM, Fischer A, et al. A quantitative, risk-based approach to the management of neonatal early-onset sepsis[J]. JAMA Pediatr, 2017, 171(4):365-371.
[36]
Carola D, Vasconcellos M, Sloane A, et al. Utility of earlyonset sepsis risk calculator for neonates born to mothers with chorioamnionitis[J]. J Pediatr, 2018, 195:48-52.e1.
[37]
Sivanandan S, Soraisham AS, Swarnam K. Choice and duration of antimicrobial therapy for neonatal sepsis and meningitis[J]. Int J Pediatr, 2011, 2011:712150.
[38]
Kempley S, Kapellou O, McWilliams A, et al. Antibiotic treatment duration and prevention of complications in neonatal Staphylococcus aureus bacteraemia[J]. J Hosp Infect, 2015, 91(2):129-135.
[39]
Carr D, Barnes EH, Gordon A, et al. Effect of antibiotic use on antimicrobial antibiotic resistance and late-onset neonatal infections over 25 years in an Australian tertiary neonatal unit[J]. Arch Dis Child Fetal Neonatal Ed, 2017, 102(3):F244-F250.
[40]
Schulman J, Dimand RJ, Lee HC, et al. Neonatal intensive care unit antibiotic use[J]. Pediatrics, 2015, 135(5):826-833.
[41]
Leroux S, Zhao W, Bétrémieux P, et al. Therapeutic guidelines for prescribing antibiotics in neonates should be evidence-based:a French national survey[J]. Arch Dis Child, 2015, 100(4):394-398.
[42]
Patel SJ, Saiman L. Principles and strategies of antimicrobial stewardship in the neonatal intensive care unit[J]. Semin Perinatol, 2012, 36(6):431-436.
[43]
Lee KR, Bagga B, Arnold SR. Reduction of broad-spectrum antimicrobial use in a tertiary children's hospital post antimicrobial stewardship program guideline implementation[J]. Pediatr Crit Care Med, 2016, 17(3):187-193.
[44]
Cantey JB, Wozniak PS, Pruszynski JE, et al. Reducing unnecessary antibiotic use in the neonatal intensive care unit (SCOUT):a prospective interrupted time-series study[J]. Lancet Infect Dis, 2016, 16(10):1178-1184.
