Fellow St Christopher Hospital for Children's Saint Christopher's Hospital for Children Philadelphia, Pennsylvania, United States
Background: Antibiotics are widely prescribed in the NICU and duration of antibiotic prescription for common neonatal indications is varied. Review of antibiotic use in our NICU in 2019 revealed 65.7% of total antibiotic indications were either rule-out sepsis, culture negative sepsis (CNS), tracheitis, or pneumonia (Figure 1). We aimed to reduce unnecessary antibiotic exposure as our antibiotic stewardship strategy.
Objective: To decrease unnecessary antibiotic exposure for the most common indications in our out-born Level 4 NICU by 20% within 1 year
Design/Methods: A multidisciplinary antibiotic stewardship team used the model for improvement to identify the primary drivers for unnecessary antibiotic exposure. On 1/2020 a consensus for the duration of antibiotics was implemented: 2 days for rule-out sepsis, 5 days for CNS, 5 days for tracheitis, and 7 days for pneumonia. Automatic stop dates were simultaneously implemented in the electronic order. On 5/2020, provider justification for treatment duration was requested and on 08/2020 re-education of previous interventions and a new gentamicin dosing recommendation was implemented. The outcome measures included percent of unnecessary antibiotic exposure defined as duration beyond consensus and mean duration of antibiotic therapy and total antibiotic use calculated as Days of therapy per 1000 patient-days (DOT-1000PD) pre and post intervention. The process measure was the use of antibiotic stop dates. The balancing measure was re-initiation of antibiotics within 2 weeks for any indication.
Results: A total of 233 patients were prescribed antibiotics during the study period (134 in baseline period and 94 in post-intervention). Percent of unnecessary antibiotic exposure decreased from 42% to 8.9% (Figure 2). Mean duration of therapy for rule-out sepsis decreased from 2.37 to 2.06 days (p <0.01), and tracheitis from 6.48 to 5.32 days (p= 0.003). No difference was seen in mean duration for CNS or pneumonia. Combined antibiotic use for the 4 primary indications reduced from 73.16 to 60.55 DOT-1000PD, a decrease of 17.23%. Compliance with antibiotic stop dates was 69%. There was no change in re-initiation of antibiotics for any indication within 2 weeks. Conclusion(s): Inter-prescriber variability was reduced by implementation of a consensus antibiotic therapy duration, justification for therapy duration and use of antibiotic stop dates. A reduction in unnecessary antibiotic use can be achieved in a level 4 NICU.
Authors/Institutions: Dipen P. Vyas, Saint Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States; Vilmaris Quinones Cardona, St Christopher's Hospital for Children/Drexel University College of Medicine, Philadelphia, Pennsylvania, United States; Kimberly Pough, Saint Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States; Megan Young, Saint Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States; Emily Souder, St Christophers Hospital for Children, Philadelphia, Pennsylvania, United States; Laura Henderson, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States; Margaret A. Gilfillan, St Christopher’s Hospital for Children, Philadelphia, Pennsylvania, United States; Alison Carey, Drexel University College of Medicine, Moorestown, New Jersey, United States
