Background: Excessive use of antibiotics is common in the NICUs. Antimicrobial stewardship program (ASP) is a key strategy to optimize antibiotic use and improve clinical outcomes; however challenges exist for effective ASPs in the NICUs.
Methods: In 2015, collaboration between ASP and NICU was initiated to assist clinicians in optimization of antimicrobial utilization. A prospective audit and feedback on infants on broad-spectrum antibiotics was conducted weekly. Construction of NICU-specific antibiogram to guide empiric therapy decisions, development of the standardized algorithms of early- and late-onset sepsis with guidance on choices and duration of antimicrobial therapy for common infectious syndromes, and prescriber education were implemented as a part of stewardship efforts. ASP interventions were reviewed to determine the areas of improvement. Antimicrobial use measured in Days of Therapy (DOT) per 1000 patient-days was evaluated.
Results: Between 7/2015-5/2016, 250 patient profiles were reviewed. A total of 130 (47%) interventions were identified. The common diagnoses associated with ASP recommendations were ventilator-associated infection (28%) and culture-negative sepsis (22%) (Fig 1). Antibiotic discontinuation (30%) and dosing optimization (19%) were the most often ASP recommendation. ASP team was less likely to intervene in patients with empiric therapy compared to definitive therapy (36% vs 50%, p= 0.06). Overall, 79% of ASP interventions were either fully or partially accepted by the prescribers. The majority (92%) of dosing optimizing recommendations was accepted. Whereas the acceptance rate for discontinuation and de-escalation of antibiotics was 77% and 44%, respectively (Fig 2). Interventions were not accepted frequently in ventilator-associated infection (Fig 3). Broad spectrum antimicrobial days/1000 patient days decreased during the intervention period from 374 to 318 (p=0.08).
Conclusion: Due to a great practice variation among neonatologists, sustaining an effective ASP in the NICU continues to pose a challenge. Decrease broad-spectrum antibiotic consumption was seen after implementation of ASP in the NICU. However, further work is needed to assess the impact of ASP with clinical outcome metrics.
N. Srikumar, None
T. Y. Lin, None
J. Holmen, None
M. Gentry, None
M. Luu, None