Optimizing antibiotic use for early onset sepsis: A tertiary NICU experience

• Published in: Journal of neonatal-perinatal medicine Vol. 12; no. 3; pp. 301 - 312
• Main Authors: Arora, V, Strunk, D, Furqan, S H, Schweig, L, Lefaiver, C, George, J, Prazad, P
• Format: Journal Article
• Language: English
• Published: Netherlands 2019
• Subjects: Ampicillin - administration & dosage; Anti-Bacterial Agents - administration & dosage; Antimicrobial Stewardship - methods; Female; Gentamicins - administration & dosage; Hospitalization - statistics & numerical data; Humans; Infant, Newborn; Intensive Care Units, Neonatal - statistics & numerical data; Intensive Care, Neonatal - methods; Male; Neonatal Sepsis - drug therapy; Patient Care Team; Practice Patterns, Physicians' - statistics & numerical data; Referral and Consultation - statistics & numerical data; Risk Assessment; Tertiary Care Centers - statistics & numerical data; Treatment Outcome; Unnecessary Procedures - statistics & numerical data; EOS calculator; 36-hour time-out; Antibiotic stewardship; SRC
• ISSN: 1934-5798; 1878-4429
• DOI: 10.3233/NPM-180075

Neonatal antibiotic use is associated with a greater risk of nosocomial infection, necrotizing enterocolitis, and mortality. It can induce drug-resistant pathogens that contribute to increased neonatal morbidity/mortality, healthcare costs, and length of stay. Prior to the antibiotic stewardship program, decisions to obtain blood cultures and empiric antibiotics for possible Early-onset Sepsis (EOS) in late preterm and term infants upon NICU admission were provider-dependent rather than algorithm-based. We aimed to decrease empiric antibiotic prescription from 70% to 56% (20% decrease) in infants ≥34 weeks gestation admitted to the NICU. The stewardship initiative comprised the following practice changes: (1) use of the Neonatal Sepsis Risk Calculator (SRC); and (2) a 36-hour time-out for prescribed empiric antibiotics. Data was retrospectively collected and analyzed for inborn infants pre-intervention (January 2015-December 2015; n = 263) and post-intervention (August 2016-September 2017; n = 279). Data regarding compliance with the new antibiotic guideline were collected and disseminated to the team every week. Overlap between CDC guidelines and calculator recommendations were studied. Pre-and post-intervention outcomes were analyzed using chi-square tests. There was a significant post-intervention reduction in the rate of both antibiotic prescriptions (29.4% decline; 70.3% vs. 49.6%; p < 0.001) and sepsis evaluations (24.3% decline; 90.9% vs. 68.8%; p < 0.001). No difference (p = 0.271) in culture-positive EOS cases was observed. There was 92% overlap in blood culture recommendations and 95% overlap between antibiotic recommendations when current CDC guidelines were compared to the SRC. A significant reduction in antibiotic use and sepsis evaluations was achieved for late preterm and term infants upon NICU admission. No clinical deterioration occurred in post-intervention infants who did not receive antibiotics. There is significant overlap between CDC guidelines and SRC recommendations.