ArticleEClinicalMedicine2021
A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study.
Article in EClinicalMedicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 3 of them syntheses that pooled it.
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Who cites it
53 citing papers in PubMed, 3 syntheses or guidelines pooled it, 79 citations in OpenAlex.
- Strategies to reduce antimicrobial resistance in newborns in low-income and middle-income countries: a systematic review and meta-analysis.The Lancet. Global health · 2026Pooled it
- A systematic review of Perinatal Antibiotic Stewardship - where we are, where to go?Journal of perinatology : official journal of the California Perinatal Association · 2025Pooled it
- Pathogenic characterization and drug resistance of neonatal sepsis in China: a systematic review and meta-analysis.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2025Pooled it
- Optimised versus standard dosing of vancomycin in infants with Gram-positive sepsis (NeoVanc): a multicentre, randomised, open-label, phase 2b, non-inferiority trial.The Lancet. Child & adolescent health · 2022Trial
- Incidence and risk factors of vancomycin-associated nephrotoxicity among neonates in the intensive care unit: a retrospective cohort study.Pediatric nephrology (Berlin, Germany) · 2026Article
- Delineating the risk factors, sources of acquisition and clinical outcomes in neonates colonised with multidrug-resistant bacteria: the NeoCol study.Nature communications · 2026Article
- Evaluating the duration of post-discontinuation therapeutic ampicillin exposures in preterm infants.Journal of perinatology : official journal of the California Perinatal Association · 2026Article
- Antimicrobials for neonates: evaluation and prescribing practices in Australian neonatal units.BMC pediatrics · 2026Article
- Variations in antibiotic use in late preterm and term newborns from 2012 to 2020: a nationwide population-based observational study.Archives of disease in childhood. Fetal and neonatal edition · 2026Observational
- Institutional Practices Drive Antibiotic Variability in Neonatal Intensive Care Units: Baseline Evidence to Inform National Stewardship Interventions in Oman.Antibiotics (Basel, Switzerland) · 2026Article
- Prescription precision: Evaluating antimicrobial prescription practices in paediatric and neonatal inpatients.Southern African journal of infectious diseases · 2026Article
- Implementation of the early-onset sepsis calculator in a tertiary care NICU.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- Comprehensive analysis ofGut microbes · 2025Article
- Antifungal Prescription and Stewardship in Pediatrics.Mycopathologia · 2025Review
- Clinical impact of an antibiotic stewardship program in a neonatal intensive care unit at a tertiary care hospital: a prospective quasi-experimental clinical study.Journal of pharmaceutical health care and sciences · 2025Article
- The association of early antibiotic exposure with subsequent development of late-onset sepsis in preterm infants: a systematic review and meta-analysis studies.International journal of emergency medicine · 2025Review
- A 10-Year Study of Neonatal Sepsis from Tuen Mun Hospital, Hong Kong.Pathogens (Basel, Switzerland) · 2025Article
- Defining and responding to the contextual drivers for implementation of antimicrobial stewardship in 14 neonatal units in South Africa.JAC-antimicrobial resistance · 2025Article
- Theoretical impact of a bedside decision-making tool on antibiotic use for suspected neonatal healthcare-associated infection: an observational study.BMC pediatrics · 2025Observational
- Understanding variation in management of early-onset neonatal sepsis in India: a vignette-based survey.BMJ paediatrics open · 2025Article
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Authors and funding
78 authors at 20 institutions in 27 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundGlobal assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts.
methodsWe conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality.
findingsOn July 1, 2019, 26% of infants (580/2,265; range, 0-100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received ≥1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were "rule-out" sepsis (32%) and "culture-negative" sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and "culture-negative" infections was 12 days (median; IQR, 8-14) and 7 days (median; IQR, 5-10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (
interpretationGlobal NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide.
fundingMerck & Co.; The Ohio State University College of Medicine Barnes Medical Student Research Scholarship.
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