Program Schedule

198
Evaluation of Antibiotic Use in the Neonatal Intensive Care Unit (NICU): from an Antimicrobial Stewardship (AMS) perspective

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Neonatal infections result in significant morbidity, mortality and increased health care costs. Antibiotics are commonly prescribed to infants hospitalized in the Neonatal Intensive Care Unit (NICU). Broad spectrum antibiotic exposure has been associated with emergence of resistant organisms and disruption in the development of normal flora.  There is paucity of data evaluating the appropriateness of antibiotic use in the NICU, based on Centre for Disease Control (CDC) 12-Step Guidelines to Prevent Antimicrobial Resistance.

Methods: A retrospective audit of antibiotic use at a tertiary perinatal centre covering four million population was conducted during Jul 2010 – Jun 2013. Our objective was to assess the practice of antibiotic therapy for compliance to the recommendations of the CDC 12-step campaign.   

Results: We audited vancomycin, meropenem and linezolid use in the NICU. Empirical use >3-day without appropriate specimens collected, or utilization despite narrower spectrum antibiotic available, were considered inappropriate use.

 

Agent

CDC 12-step violation

Inappropriate use examples

Meropenem

4

Continued use despite organism is sensitive to 3rd generation cephalosporins

9

Prolonged empirical use without collecting appropriate specimens / redundant coverage with metronidazole

Vancomycin

4

Treatment for ampicillin-sensitive (amp-S) Enterococcus or methicillin-sensitive Staphylococcus aureus (MSSA)

9

Prolonged empirical use without collecting appropriate specimens

Linezolid

4

Treatment for (amp-S) Enterococcus or MSSA or Enterobacteriaceae

 

Agent

Antibiotic Courses

Duration         (Median days, IQR)

Antibiotic Days

Proportion of Inappropriate Prescription

Meropenem

57

3 [7, 14]

525

10/57 (17.5%)

Vancomycin

133

7 [5, 11]

1204

48/133 (36.0%)

Linezolid

35

7 [3,9]

233

6/35 (17.1%)

Conclusion: The CDC 12-Step Campaign is feasible in the NICU setting. Inappropriate antibiotic prescriptions are not uncommon in relation to the use of meropenem, vancomycin and linezolid. Attention should be focused on timely streamlining of these antimicrobials and collection of appropriate microbiologic specimens.

Joseph Ting, MBBS, FRCPC, MPH1, Karen Ng, B.Sc. Pharm., PharmD2, Simon Dobson, MD, FRCPC1, Peter Tilley, MD, FRCPC3, Horacio Osiovich, MD, FRCPC1, Don Hamilton, BSc.Pharm.2, Srinivas Murthy, MD, FRCPC1 and Ashley Roberts, MD, M.Ed., FRCPC1, (1)Pediatrics, University of British Columbia, Vancouver, BC, Canada, (2)Pharmacy, BC Children's Hospital, Vancouver, BC, Canada, (3)Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada

Disclosures:

J. Ting, None

K. Ng, None

S. Dobson, None

P. Tilley, None

H. Osiovich, None

D. Hamilton, None

S. Murthy, None

A. Roberts, None

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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