Strategic use of antibiotics in the neonatal intensive care unit

Infection is one of the most common causes of infant morbidity and mortality in the neonatal intensive care unit, despite the availability of various therapeutic medical interventions, such as mechanical ventilation, that allow premature infants a better chance of survival. In fact, many of these therapeutic interventions violate the natural protective barriers for infection. Fortunately, maternal and neonatal risk factors have been identified for early- and late-onset sepsis and the prevalence of highly suspected pathogens for each type of infection influences the empiric selection of antibiotics. In many institutions, the common pathogens have developed resistance to antibiotics. In others, the predominance of pathogens has shifted. Both challenges may warrant modification of traditional antibiotic regimens. Continual monitoring of pathogen shifts within an individual neonatal intensive care unit and application of various antibiotic characteristics are key elements of strategic, safe, and effective use of antibiotics in this patient population. Development of a protocol incorporating infection control measures and guidelines for judicious use of antibiotics can minimize the threat of antibiotic resistance.