Antimicrobial Stewardship Programs in Neonates: A Meta-Analysis

This article reviews the components of neonatal antimicrobial stewardship programs (ASP) and their effects on clinical outcomes, cost-effectiveness, and antimicrobial resistance. Out of 4048 studies, 70 met the inclusion criteria. Moderate-certainty evidence shows a significant reduction in antimicrobial initiation in NICU and combined NICU and postnatal ward settings, duration of antimicrobial agents therapy, length of therapy, and use of antimicrobial agents >5 days. Low-certainty evidence reveals a reduction in economic burden and drug resistance, favorable sustainability metrics, without an increase in sepsis-related mortality or the reinitiation of antimicrobial agents. Studies had heterogeneity with significant variations in ASP interventions, population settings, and outcome definitions. In conclusion, moderate- to low-certainty evidence reveals that neonatal ASP interventions are associated with a reduction in the initiation and duration of antimicrobial use, without an increase in adverse events.