title: Use and misuse of antibiotics in the neonatal intensive care unit.
abstract: Severe infections represent the main cause of neonatal mortality accounting for more than one million neonatal deaths worldwide every year. Antibiotics are the most commonly prescribed medications in neonatal intensive care units (NICUs) and in industrialized countries about 1% of neonates are exposed to antibiotic therapy. Signs and symptoms of sepsis are nonspecific, and empiric antimicrobial therapy is promptly initiated after obtaining appropriate cultures in order to prevent deleterious consequences. However, many preterm infants who do not have infection receive antimicrobial agents during hospital stay and antibiotic treatment in the setting of negative cultures can have serious adverse effects like: promotion of bacterial antibiotic resistance, alteration of gut colonization, increase risk of Candida colonization and subsequent invasive candidiasis, increase risk of death, necrotizing enterocolitis and late-onset sepsis. Appropriate choice of antimicrobial agents and optimal duration of therapy in neonates with suspected or culture-proven sepsis is essential in order to prevent serious consequences. Moreover the establishment of an antibiotic stewardship programme in the NICUs is the best way of ensuring neonatal infections remain treatable while efforts are made for the developing of optimal antibiotic prescribing.
authors.affiliation: Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. c.tzialla@smatteo.pv.it
authors.forename: C
authors.initials: C
authors.lastname: Tzialla
authors.forename: A
authors.initials: A
authors.lastname: Borghesi
authors.forename: G F
authors.initials: GF
authors.lastname: Perotti
authors.forename: F
authors.initials: F
authors.lastname: Garofoli
authors.forename: P
authors.initials: P
authors.lastname: Manzoni
authors.forename: M
authors.initials: M
authors.lastname: Stronati
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D015331:Cohort Studies; D062787:Drug Overdose / Q000453:epidemiology* / Q000209:etiology; D004352:Drug Resistance, Microbial / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000188:drug therapy* / Q000453:epidemiology; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents