Implementation of the Smart Use of Antibiotics Program to Reduce Unnecessary Antibiotic Use in a Neonatal ICU: A Prospective Interrupted Time-Series Study in a Developing Country

Abstract

Objectives: We aimed to implement our Smart Use of Antibiotics Program to ensure the proper use of antimicrobials, improve patient care and outcomes, and reduce the risks of adverse effects and antimicrobial resistance. Design: We compared the time periods before (baseline) and after (intervention) the implementation of an antibiotic protocol by performing surveillance and assessments of all antibiotic use during a 29-month interrupted period. Setting: Level 3–4 neonatal ICU in one referral center. Patients: All 13,540 infants who received antibiotics during their hospital stay from 2015 to 2017. Interventions: Prospective audit of targeted antibiotic stewardship program. Measurements and Main Results: The primary outcome was the change in total antibiotic days of therapy per 1,000 patient-days between the baseline and intervention periods. The secondary outcomes included readmissions for infection, late-onset sepsis (length of stay), necrotizing enterocolitis, or death in infants at 32 weeks of gestation or younger and the prevalence of multidrug-resistant organism colonization. No differences in safety outcomes were observed between the intervention and baseline periods. Following the implementation of our Smart Use of Antibiotics Program, the total quantity of antibiotics in the intervention phase was significantly decreased from 543 days of therapy per 1,000 patient-days to 380 days of therapy/1,000 patient-days compared with that of baseline (p = 0.0001), which occurred in parallel with a reduction in length of stay from 11.4% during the baseline period to 6.5% during the intervention period (p = 0.01). A reduced multidrug-resistant organism rate was also observed following Smart Use of Antibiotics Program implementation (1.4% vs 1.0%; p = 0.02). The overall readmission rate did not differ between the two periods (1.2% vs 1.1%; p = 0.16). Conclusions: Smart Use of Antibiotics Program implementation was effective in reducing antibiotic exposure without affecting quality of care. Antibiotic stewardship programs are attainable through tailoring to special stewardship targets even in a developing country.

Impact of Chlorhexidine Bathing on Antimicrobial Utilization in Surgical Intensive Care Unit

“…26 In another prospective study conducted at a neonatal ICU in one referral center in China, the introduction of the Smart Use of Antibiotic Program reduced the antimicrobial use by À16.3 agent-days/100 patient-days (54.3 before versus 38 after; P ¼ 0.0001). 27 Given that our study's sample size (n ¼ 312) is much smaller than both of the aforementioned studies (n ¼ 57,195 and n ¼ 13,540, respectively), 26,27 larger studies are warranted to confirm the effects of chlorhexidine bathing (alone or in combination with antimicrobial stewardship program) on total antimicrobial utilization in the ICU. Our study included a large surgical and liver transplant patient population, which often received empirical and prophylaxis antimicrobials such as fluconazole.…”

Antibiotic Stewardship in Premature Infants: A Systematic Review

“…Cantey et al achieved a reduction from 343.2 to 252.2 DOT [19]. Lu et al [28] achieved a decrease from 543 to 380 DOT. McCarthy et al [29] reduced antibiotic use from 572 to 417 DOT after second intervention.…”

“…Kitano et al [27] achieved a reduction of prolonged antimicrobial treatments from 65 to 32.5%. Lu et al [28] had an increase in percentage of discontinued antibiotic courses ≤48 h from 32 to 95%. Tolia et al [34] lowered percentage of infants with >48 h of antibiotic exposure from 63.4 to 41.3%.…”

“…The same was done by Cantey et al [19], additionally limiting treatment duration of culture-negative sepsis and pneumonia to 5 days. Tolia et al and Lu et al [28, 34] implemented an automatic stop order at 48 h in addition to other educational and organizational ASP actions, respectively. McCarthy et al [29] specifically targeted prolonged antibiotic courses in their second of 2 intervention periods, implementing an automatic stop after 36 h in asymptomatic infants with 2 negative CRP and negative blood culture.…”

Status of Oxygen Monitoring in Four Selected Special Care Newborn Units in India

“…Characteristics between audits were compared using chi-squared tests and t-tests for categorical and continuous variables respectively. Inpatient and total days of therapy were calculated to assess antibiotic exposure [11]. The manuscript was prepared using the SQUIRE template [12].…”