175. Implementation of Clinical Practice Guidelines for Care of Neonates with Necrotizing Enterocolitis Reduces Broad Spectrum Antibiotic Use in the Neonatal Intensive Care Unit
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions in Pediatric Populations
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • IDWeek 2018 ASP NEC CPG Poster.pdf (1.6 MB)
  • Background: Exposure to broad spectrum antimicrobial agents (AA) is a known risk factor for colonization and infection with multidrug resistant organisms (MDROs).  Therapy with broad spectrum AAs is commonplace with no published guideline to help minimize their use in the NICU.  We aimed to analyze clinical indications for the use of vancomycin and meropenem (V/M) in the NICU and the impact of a necrotizing enterocolitis (NEC) clinical practice guideline (CPG) on the use of V/M in the NICU. 

    Methods: Patients who received V/M between 01/2015-12/2015 were identified using pharmacy administration data. Medical charts were reviewed retrospectively by 2 ID physicians to determine if V/M were clinically indicated for each definitive course.  A CPG outlining optimal use of AAs for NEC was implemented in the NICU in our institution in 8/2015 (Fig 1). We analyzed V/M DOT per 1000 patient days before and after CPG implementation.  There were no parallel changes in antimicrobial stewardship interventions.  

    Results: At the start of V/M, mean gestation and chronologic age of the study population was 28.8 weeks and 26.9 days respectively, and the mean weight was 2676 grams. During the study period, 91 patients received 191 courses of vancomycin and 27 patients received 32 courses of meropenem; ~40% of V/M definitive use did not have a clear clinical indication (Table 1). 33% of meropenem definitive use was in infants with NEC.  During a seven-month baseline period, mean vancomycin and meropenem use was 105 and 56 DOTs per 1000 patient days, respectively.  Following NEC CPG implementation, mean vancomycin and meropenem use was 101 and 12 DOTs per 1000 patient days, respectively (Fig. 2 and 3).  

    Conclusion: Widespread use of V/M was identified in the NICU. Following implementation of NEC CPG, there was decrease in the utilization of meropenem in the NICU.

    https://documents.lucidchart.com/documents/4401c231-899d-47d2-a7b8-108a2185e577/pages/0_0?a=1758&x=21&y=5&w=1728&h=1210&store=1&accept=image%2F*&auth=LCA%208ab5194011181d05eca2a5ceb6c71f7af2bd1b69-ts%3D1525192530

     

    Table 1.  Clinical Indication Determination of V/M Definitive Courses (n) 

    Vancomycin (n=73)

    Meropenem (n=15)

    Clearly Indicated (clinical cultures warrant use)

    18 (25%)

    4 (27%)

    Likely Indicated (sepsis in setting of known MDRO colonization)

    5 (7%)

    3 (20%)

    Clearly Not indicated (clinical cultures warrant narrowing)

    30 (41%)

    6  (40%)

    Unclear if Indicated (critically ill infant but no known MDRO colonization and negative culture data)

    20 (27%)

    2 (13%)

     

    Jonathan Albert, MD1, Ishminder Kaur, MD2, Geoffrey Bajwa, MD3, Suzanne Touch, MD3, Emily Souder, MD2, Sarah Long, MD2 and Vineet Bhandari, MD3, (1)Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, PA, (2)Section of Infectious Diseases, St. Christopher's Hospital for Children, Philadelphia, PA, (3)Section of Neonatal-Perinatal Medicine, St. Christopher's Hospital for Children, Philadelphia, PA

    Disclosures:

    J. Albert, None

    I. Kaur, None

    G. Bajwa, None

    S. Touch, None

    E. Souder, None

    S. Long, None

    V. Bhandari, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.