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

Abstract

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.

Neonatal Nurse and Nurse Practitioner Engagement in Antibiotic Stewardship

“…4 Antibiotics are the most common medication prescribed in NICUs, with wide variability in use, regardless of the level of care or complexity of patients. 5 On any given day, 40% of infants admitted to a NICU are prescribed antibiotics, with an estimated 90% exposed to antibiotics over the duration of their NICU stay. 3 A recent study published in The Lancet Regional Health-Southeast Asia found that the most commonly prescribed antibiotics in Southeast Asia are now only 50% effective at treating sepsis and meningitis in newborns.…”

“…6 Furthermore, there is increasing evidence that preterm infant antibiotic exposure is associated adverse outcomes including alteration in the intestinal microbiome, necrotizing enterocolitis, invasive fungal infections, retinopathy, and late-onset sepsis. 5 Early life antibiotic exposure is also associated with future health problems including childhood obesity, asthma, allergic disorders, and inflammatory bowel disease. 5 Therefore, it is important to find strategies to reduce antibiotic use in the NICU patient population.…”

“…5 Early life antibiotic exposure is also associated with future health problems including childhood obesity, asthma, allergic disorders, and inflammatory bowel disease. 5 Therefore, it is important to find strategies to reduce antibiotic use in the NICU patient population.…”

“…Antibiotics are the most common medication prescribed in NICUs, with wide variability in use, regardless of the level of care or complexity of patients 5. On any given day, 40% of infants admitted to a NICU are prescribed antibiotics, with an estimated 90% exposed to antibiotics over the duration of their NICU stay 3.…”

“…A recent study published in The Lancet Regional Health-Southeast Asia found that the most commonly prescribed antibiotics in Southeast Asia are now only 50% effective at treating sepsis and meningitis in newborns 6. Furthermore, there is increasing evidence that preterm infant antibiotic exposure is associated adverse outcomes including alteration in the intestinal microbiome, necrotizing enterocolitis, invasive fungal infections, retinopathy, and late-onset sepsis 5. Early life antibiotic exposure is also associated with future health problems including childhood obesity, asthma, allergic disorders, and inflammatory bowel disease 5.…”