Table 2 Summary of important methodological aspects and research questions for future studies in perinatal antimicrobial stewardship.
From: A systematic review of Perinatal Antibiotic Stewardship – where we are, where to go?
Five important methodological aspects for future studies in perinatal antimicrobial stewardship |
Mother and infant belong together: Paired data collection of mother and infant by linked medical and research databases including maternal and neonatal antibiotics |
Environment is key: Consider ethnically, racially and culturally diverse populations including low- and middle-income countries with a high burden of maternal and neonatal morbidity and mortality |
Prospective planning for high-quality research: Strive for prospective randomized trials or adaptive multi-arm, multi-stage study designs (e.g. platform trials) |
Non-inferiority aspect: Powered for safety outcomes as missed sepsis cases, delayed start of antibiotics in case of infections, morbidity and mortality (burden of disease) |
Superiority aspect: Antibiotic use and long-term follow-up or proxy for clinical outcomes and/or antimicrobial resistance rates or microbiome analyses including antimicrobial resistance genes (burden of therapy) |
Five important research questions for future studies in perinatal antimicrobial stewardship |
Antibiotic use in pregnancy: What algorithm can accurately assess the risk of suspected maternal infections in pregnancy, and how can we ensure compliance by health care workers in prescribing empiric antibiotic therapy? |
Antibiotic use in neonates: What algorithm can accurately assess the risk of suspected neonatal bacterial infections, and how can we ensure compliance by health care workers in prescribing empiric antibiotic therapy? |
Antibiotic prophylaxis: How can we safely reduce perinatal antibiotic prophylaxis in specific situations and what are conditions necessary to safely administer prophylaxis for caesarean section after cord clamping? |
New technologies: How can we use newer technologies for early detection of pathogens and AMR, or AI and machine learning to support diagnostic accuracy and antibiotic prescription decisions? |
Effect of antibiotics: What effect has a single dose of intrapartum or postpartum antibiotics on the developing neonatal microbiome and clinical outcomes and does this effect depend on the type of antibiotic administered? |
