567 - Variations in antimicrobial usage in 12 international networks

Publication Number: 567.7103

Joanna Seliga-Siwecka, Medical University of Warsaw, Warsaw, Mazowieckie, Poland; Justyna Romańska, Department of Obstetrics and Gynaecology, Division of Neonatology and Neonatal Intensive Care, Medical University of Warsaw, Warszawa, Mazowieckie, Poland; Kei Lui, University of New South Wales, Sydney, New South Wales, Australia; Marisa M. Mussi-Pinhata, Ribeirão Preto Medical School, University Of São Paulo, Brasil., Ribeirão Preto, Sao Paulo, Brazil; Laura San Feliciano, Hospital Universitario de Salamanca, Salamanca, Castilla y Leon, Spain; Liisa Lehtonen, University of Turku, Turku, Varsinais-Suomi, Finland; Kjell Helenius, University of Turku, Turku, Varsinais-Suomi, Finland; Maximo Vento, Instituto de Investigación Sanitaria La Fe, VALENCIA, Comunidad Valenciana, Spain; Satoshi Kusuda, Neonatal Research Network of Japan, Taito, Tokyo, Japan; Dirk Bassler, University Hospital of Zurich, Zurich, Zurich, Switzerland; Valerie Biran, Robert Debre Children's Hospital, Assistance Publique Hôpitaux de Paris,University Paris-Cité, INSERM U1141, France, Paris, Ile-de-France, France; Gil Klinger, Schneider Children's Medical Center of Israel and Tel Aviv University, Ramat Hasharon, HaMerkaz, Israel; Tetsuya Isayama, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan; Monia Puglia, Regional Healthcare Agency of Tuscany, Florence, Toscana, Italy; Malcolm Battin, Auckland City Hospitial, Auckland, Auckland, New Zealand; Mikael Norman, Karolinska Institutet, Stockholm, Stockholms Lan, Sweden; Mark Adams, University Hospital Zurich, Zurich, Zurich, Switzerland; Brian Reichman, Sheba Medical Center, Ramat Gan, HaMerkaz, Israel; Marc Beltempo, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada; Prakesh S. Shah, Mount Sinai Hospital, Toronto, ON, Canada; Neha Goswami, Mount Sinai Hospital, Toronto, ON, Canada

Background: Antibiotics in preterm newborns are responsible for antimicrobial resistance and dysregulation of the microbiome. Fear of missing an evolving infection leads to overtreatment. Furthermore, antibiotic treatment for proven infections is not uniform. Hence, antibiotic stewardship remains a major challenge in the NICU.

Objective: To survey the variations in antibiotic stewardship in preterm neonates of < 29 weeks’ gestation among neonatal units of 12 population-based national or regional neonatal networks participating in the International Network for Evaluating Outcomes in Neonates (iNeo).

Design/Methods: Online pre-piloted questionnaires were sent to the directors or representatives of 608 NICU’s participating in Australia/New-Zealand (ANZNN n= 30), Brazil (BZ=20), Canada (CNN, n=32), Finland (FinMBR, n=5), France (FR, n=70), Israel (INN, n=26), Japan (NRNJ, n=292), Poland (PL, n=56), Spain (SEN1500, n=55), Sweden (SNQ n=9), Switzerland (SwissNeoNet n=9), and Tuscany, Italy (TuscanNN n=4). The responses were based on practices in 2023.Two reminders were sent.

Results: Overall, 383 units (63%) responded. The survey response varied from 37-100% among participating networks. In infants born < 29 weeks 58 % of the units use prophylactic fungal medications (3-75%). For diagnosing infection 43 % of the units within each network routinely use one sterile site (43-100%). However, within the INN 61% networks use two sterile sites. Most centers treat gram positive sepsis for 7 days (16-89%), except for INN (52% treat for 10 days) and Japan where most centers prescribe antibiotics for 14 days (62%). We noted a larger variation in gram negative sepsis treatment, most units reported treatment for 14 days (9-65%). Most centers treat gram negative meningitis for 21 days (40-100%). Many centres treat gram positive sepsis with meningitis for 14 days (40-85%). There are significant differences in treating gram negative sepsis between the networks (7,14 or 21 days), most Canadian and Japanese units prescribe antibiotics for 21 days (53 and 60 %) respectively. Most networks (excluding Finland) treat gram negative sepsis with meningitis for 21 days (43-100%). Fungal infection is treated for 14 days in most units (28-55%), and >21days if meningitis is diagnosed (35-78%).

Conclusion(s): There were marked variations in antibiotic prophylaxis and treatment of infection in very preterm infants. Further collaboration and exploration are needed to better understand the association of these variations in practice with variations in antibiotic stewardship across different countries and units to develop evidence-based practice.

Antibiotic duration for specific micro-organisms.