Program Schedule

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Antibiotic Stewardship in the Neonatal Intensive Care Unit (NICU):  Metrics Matter!

Session: Poster Abstract Session: Pediatric Antimicrobial Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Prolonged antibiotic therapy among preterm infants in the NICU is associated with adverse outcomes including death and necrotizing enterocolitis. The optimal metric to measure antibiotic use in the NICU and thus guide stewardship efforts is unknown. The purpose of this study was to apply two different metrics of antibiotic use to a large cohort of NICU infants and compare the results.

Methods: Prospective collection and analysis of all antibiotics provided to every infant admitted to the NICU at Parkland Memorial Hospital, Dallas during a 14 month period (SCOUT study). Pertinent clinical and outcome data were collected. Two different metrics for determining antibiotic use were calculated for all antibiotics:  1) days of therapy (DOT) and 2) number of calendar days (CD) that the antibiotics were administered.  DOT was calculated by dividing the dosing interval by 24 hours, then multiplying by the number of doses, summed for each antibiotic. CD was determined by the number of days in which a dose of an antibiotic was administered. For example, a 6-dose course of q8 hour ampicillin begun Monday evening and completed Wednesday morning would equal 2 DOT (8 ÷ 24 x 6 = 2) and 3 CD (Mon, Tue, Wed = 3).

Results: 1521 infants were admitted during the study period; 364 (24%) received no systemic antibiotics and were excluded. 1157 infants (76%) accounted for 19,788 hospital days and received 1439 separate antibiotic courses. The total volume of antibiotic administered was 9394 by DOT and 5915 by CD. Agent-specific antibiotic use by DOT and CD is shown (Table).

 

Antibiotic

No. of courses

DOT

CD

% difference

All

1439

9394

5915

-37%

Gentamicin

1399

4468

4551

2%

Ampicillin

1233

3579

4417

31%

Oxacillin

181

676

874

23%

Vancomycin

41

249

276

11%

Piperacillin/tazobactam

36

171

195

14%

1st generation cephalosporins

18

10

23

130%

Penicillin

12

69

77

12%

3rd generation cephalosporins

6

10

13

30%

Meropenem

5

26

30

14%

Metronidazole

4

38

42

11%

Other

14

98

115

17%

Conclusion: Antibiotic use in the NICU varies substantially by the metric used. When used to describe a course of antibiotics, CD does not account for the number of agents. When used for specific agents, CD overestimates therapy volume by 13% on average. Our ongoing evaluation of which metric best predicts adverse outcomes is important to guide antibiotic stewardship efforts.

Joseph Cantey, MD1, Sean Nguyen, PharmD, BCPS2, Phillip Wozniak1 and Pablo J. Sanchez, MD, FIDSA3, (1)Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, (2)Pharmacy, Children's Medical Center Dallas, Dallas, TX, (3)Pediatrics, Nationwide Children's Hospital - The Ohio State University, Columbus, OH

Disclosures:

J. Cantey, None

S. Nguyen, None

P. Wozniak, None

P. J. Sanchez, None

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