Antimicrobial stewardship and infection prevention in the neonatal intensive care unit

Abstract

Newborns can become critically ill from bacterial infections, a condition known as neonatal sepsis. The initial symptoms of neonatal sepsis are often subtle, leading to the treatment of thousands of newborns with antibiotics each year in the Netherlands. Preterm infants, who frequently require additional care, are particularly at risk for infection. However, the number of infants with a proven bacterial infection remains small. Antibiotics can disrupt the gut microbiota of newborns, potentially leading to colonization with multidrug-resistant organisms (MDROs). MDRO infections are more challenging to treat and may result in poorer outcomes. Reducing antibiotic use may potentially lead to a decrease in the colonization with MDRO and consequently, a reduction in infections caused by these organisms. Research described in this dissertation indicates that antibiotic treatment can be safely discontinued after 24 hours in certain groups of newborns, thereby potentially reducing the length of hospital admission. Additionally, the implementation of a novel laboratory test for meningitis may allow for shorter and lower-dose antibiotic treatments in newborns. Investigations into the transmission of MDROs in the neonatal ward have revealed that caring for newborns in single-patient rooms does not protect them from acquiring MDRO colonization.