Determining Time to Positivity of Blood Cultures in a Neonatal Unit

Arias-Felipe, Ana; Ramírez-Berrios, Jesús; Recio‐Martínez, Raúl; Orellana, María Ángeles; Fontiveros-Escalona, Diego; Bergón-Sendín, Elena; Alba-Romero, Concepción de

doi:10.1093/jpids/piac084

Cited by 10 publications

(9 citation statements)

References 12 publications

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“…We determined this timeframe using unit-specific time-to-positivity data and studies published in similar patient populations. 25–27 We believe that limiting the duration of empiric antibiotics, in addition to ongoing education and stewardship practices, decreased the use of all monitored antibiotics and prevented an increase in the use of narrower spectrum agents with the implementation of our empiric algorithm. We acknowledge that automatic stop times may lead to unintentional interruptions in antibiotic therapy and require close monitoring by team members.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial Stewardship and Improved Antibiotic Utilization in the Pediatric Cardiac Intensive Care Unit

Hillyer,

Jaggi,

Chanani

et al. 2024

Pediatric Quality &Amp; Safety

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Background: We developed a multidisciplinary antimicrobial stewardship team to optimize antimicrobial use within the Pediatric Cardiac Intensive Care Unit. A quality improvement initiative was conducted to decrease unnecessary broad-spectrum antibiotic use by 20%, with sustained change over 12 months. Methods: We conducted this quality improvement initiative within a quaternary care center. PDSA cycles focused on antibiotic overuse, provider education, and practice standardization. The primary outcome measure was days of therapy (DOT)/1000 patient days. Process measures included electronic medical record order-set use. Balancing measures focused on alternative antibiotic use, overall mortality, and sepsis-related mortality. Data were analyzed using statistical process control charts. Results: A significant and sustained decrease in DOT was observed for vancomycin and meropenem. Vancomycin use decreased from a baseline of 198 DOT to 137 DOT, a 31% reduction. Meropenem use decreased from 103 DOT to 34 DOT, a 67% reduction. These changes were sustained over 24 months. The collective use of gram-negative antibiotics, including meropenem, cefepime, and piperacillin-tazobactam, decreased from a baseline of 323 DOT to 239 DOT, a reduction of 26%. There was no reciprocal increase in cefepime or piperacillin-tazobactam use. Key interventions involved electronic medical record changes, including automatic stop times and empiric antibiotic standardization. All-cause mortality remained unchanged. Conclusions: The initiation of a dedicated antimicrobial stewardship initiative resulted in a sustained reduction in meropenem and vancomycin usage. Interventions did not lead to increased utilization of alternative broad-spectrum antimicrobials or increased mortality. Future interventions will target additional broad-spectrum antimicrobials.

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Section: Discussionmentioning

confidence: 99%

Antimicrobial Stewardship and Improved Antibiotic Utilization in the Pediatric Cardiac Intensive Care Unit

Hillyer,

Jaggi,

Chanani

et al. 2024

Pediatric Quality &Amp; Safety

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“…However, the majority of antibiotic use in the NICU is in situations where the cultures are sterile and therein lies the relevance to every day NICU practice. (11) Recently, Arias-Felipe et al (25) have shown that in 98% of blood cultures from infants in the NICU, the time to positivity was < 24 hours. In addition, morbidity from a shortened course of empirical antibiotic therapy such as bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, and neurodevelopmental outcomes was not investigated.…”

Section: Discussionmentioning

confidence: 99%

Short-course empiric antibiotic therapy for possible early-onset sepsis in the NICU

et al. 2023

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Objective. On 2/2019, the Neonatal Antimicrobial Stewardship Program at Nationwide Children's Hospital recommended reducing empirical antibiotic therapy for early-onset sepsis (EOS) from 48 to 24 hours with a TIME-OUT. We describe our experience with this guideline and assess its safety.Methods. Retrospective review of all newborns evaluated for possible EOS at <72 hours of age at 6 neonatal intensive care units from 12/2018-7/2019. Safety endpoints were re-initiation of antibiotics within 7 days after discontinuation of the initial course, positive bacterial blood or cerebrospinal uid culture in the 7 days after antibiotic discontinuation, and overall and sepsis-related mortality.Result. Among 414 newborns evaluated for EOS, 196 (47%) received a 24 hour rule-out sepsis antibiotic course while 218 (53%) were managed with a 48 hour course. Infants in the two groups did not differ in the prede ned safety endpoints.Conclusion. Antibiotic therapy for suspected EOS may be discontinued safely within 24 hours.

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“…Similarly, Arias-Felipe et al reported that 100% of gram-negative and 97.9% of gram-positive organisms grew within 24 hours in neonatal EOS and LOS. 34 Third, by only ordering a few doses of antibiotics for EOS and discussing the results of the blood cultures during the rounds of “time-out,” we compelled our providers to write a new order for antibiotic therapy and to justify further their decision to continue antibiotic treatment in the presence of a negative blood culture. The microbiology department’s immediate reporting of blood culture results in the EMR facilitated the implementation of this strategy.…”

Section: Discussionmentioning

confidence: 99%

New strategies to Reduce Unnecessary Antibiotic Use in the NICU: A Quality Improvement Initiative

Pantoja,

Sveum,

Frost

et al. 2023

Pediatric Quality &Amp; Safety

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Introduction: Early-onset sepsis (EOS) and late-onset Sepsis (LOS) are common diagnoses entertained in sick newborns treated in neonatal intensive care units (NICUs), and antibiotics are the medications most prescribed in NICUs. Antibiotic stewardship programs have an important impact on limiting unnecessary antibiotic use. Methods: Following the Model for Improvement, between 2/1/16 and 1/31/17, at a level 3 NICU, a multidisciplinary team implemented PDSA cycles to promote antibiotic stewardship practices for newborns at risk of EOS and LOS. The main goal was to decrease the antibiotic usage rate (AUR) safely. Primary strategies included discontinuing antibiotics within 24 hours of life if the newborn was stable, and the blood culture was negative for EOS and implementing an “antibiotic time-out” during rounds. Results: For all newborns admitted to our NICU, the AUR decreased, for EOS from 137 to 32 days per 1000 patient days (77% reduction) and for LOS from 277 to 121 days per 1000 patient days (56% reduction). We demonstrated the sustainability of both EOS-AUR and LOS-AUR during the 2 years postcompletion of the intervention period. There were no adverse effects of reducing the AUR. Conclusion: Interventions that reduce unnecessary antibiotic use in the NICU are safe and prevent excessive antibiotic exposure.

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Determining Time to Positivity of Blood Cultures in a Neonatal Unit

Cited by 10 publications

References 12 publications

Antimicrobial Stewardship and Improved Antibiotic Utilization in the Pediatric Cardiac Intensive Care Unit

Antimicrobial Stewardship and Improved Antibiotic Utilization in the Pediatric Cardiac Intensive Care Unit

Short-course empiric antibiotic therapy for possible early-onset sepsis in the NICU

New strategies to Reduce Unnecessary Antibiotic Use in the NICU: A Quality Improvement Initiative

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