1445. Intervention Strategies to Reduce Late Onset Sepsis and Antibiotic Use: Impacts in a Tertiary Neonatal Intensive Care Unit (NICU)
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • IDSA POSTER.pdf (197.9 kB)
  • Background: Late Infections in NICU are a commun cause of morbidity and mortality. Antibiotis are widely used. 

    Methods: To evaluate the incidence of late onset sepsis (LOS) in our Unit and the impact of intervention protocols to reduce it and promote a more rational use of antibiotics (AB).

    On July 2013 a number of interventions were established in our NICU. Interventions:

    1. Change of empirical AB therapy for suspected LOS to cloxacilin/amikacin. Vancomycin was used only if the patient had hemodynamic compromise or a prior positive culture for MRSA or CONS.
    2. Adjust antibiotic therapy according to the antibiogram,
    3. Stop empirical AB after 36 or 48 hrs if early or late onset infection was rejected respectively,
    4. Restrictive use of 3rd generation cephalosporins (3GC) and vancomycin,
    5. "Bundles" for CVC insertion and management.

    We retrospectively reviewed all episodes of positive cultures considered as infections in hospitalized patients from 2012 to 2014. A statistical analysis was made to evaluate the impact of these interventions during the time period before and after the intervention.  Defining LOS as a positive blood culture, after the first 72 hours of life, and late onset infection as any positive blood, urine, tracheal or CSF culture after 72 hours of life.

    The results were analyzed comparatively with t student and Fischer exact test.

    Results: We considered a pre intervention period from January to December of 2012 and a post intervention period from August 2013  to July 2014.  The characteristics of the NICU population during both periods were similar.

    Our results in both periods of time are on table 1.  LOS decreased after our intervention measures, but not significantly.  Late onset infection fell significantly from 14,3 to 8,5 episodes per 1000 NB. There was a significant decrease in the use of Vancomycin and 3GC with disappearance of Candida infections.

    As a result, there was a significant decline in cost associated with AB use

    Table 1

     

    Pre intervention

    Post intervention

    p

    Inpatients of NB

    12,8

    15,2

    <0,05

    Late infection episodes

    51

    35

    <0,05

    Infections x 1000 NB

    14,3

    8,5

    <0,05

    LOS x1000 NB

    5,7

    2,9

    ns

    Empirical Vancomycin

    70%

    4%

    <0,01

    Empirical 3GC

    73%

    2%

    <0,05

    Adjusted AB optimal

    29%

    77%

    <0,01

    Conclusion: After our intervention, we have decreased late infections and antibiotic use without increasing morbidity and mortality.

    Soledad Urzúa, MD1, Patricia Garcia, MD2, Matias Luco, MD3, Amparo Sanchez, MD1 and Marcela Ferres, MD, MPH4, (1)Neonatology, Pontificia Universidad Catolica de Chile, Santiago, Chile, (2)Microbiología Laboratory, Pontificia Universidad Catolica de Chile, Santiago, Chile, (3)Neonatology, Pontificia Universidad Catolica de Chile, santiago, Chile, (4)Virology Laboratory, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

    Disclosures:

    S. Urzúa, None

    P. Garcia, None

    M. Luco, None

    A. Sanchez, None

    M. Ferres, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.