Active antibiotic discontinuation in suspected but not confirmed early‐onset neonatal sepsis—A quality improvement initiative

Abstract

Aim: To study whether a simple targeted intervention could reduce unwarranted antibiotic treatment in near-term and term neonates with suspected, but not confirmed early-onset sepsis. Methods: A quality improvement initiative in three Norwegian neonatal intensive care units. The intervention included an inter-hospital clinical practice guideline for discontinuing antibiotics after 36-48 hours if sepsis was no longer suspected and blood cultures were negative in neonates ≥ 34+0 weeks of gestation. Two units used procalcitonin in decision-making. We compared data 12-14 months before and after guideline implementation. The results are presented as median with interquartile ranges. Results: A total of 284 infants (2.5% of all births ≥ 34+0 weeks of gestation) received antibiotics before and 195 (1.8%) after guideline implementation (P = .0018). The two units that used procalcitonin discontinued antibiotics earlier after guideline implementation than the unit without procalcitonin. Neonates not diagnosed with sepsis were treated 49 (31-84) hours before and 48 (36-72) hours after guideline implementation (P = .68). In all infants, including those diagnosed with sepsis, antibiotic treatment duration was reduced from 108 (60-144) to 96 (48-120) hours (P = .013). Conclusion: Antibiotic treatment duration for suspected, but not confirmed earlyonset sepsis did not change. However, treatment duration for all infants and the proportion of infants commenced on antibiotics were reduced.

Real‐life clinical studies are needed after a quality improvement study in neonatal sepsis showed unexpected improvements

“…However, Dretvik et al observed some unexpected collateral benefit from their quality improvement initiative 6 . There was an overall 37% reduction in antibiotic treatment days from 11.4 to 7.2 per 100 near‐term and term infants.…”

“…In addition, it is very difficult to further reduce the treatment length from 49 hours in non-confirmed sepsis. However, Dretvik et al observed some unexpected collateral benefit from their quality improvement initiative6 . There was an overall 37% reduction in antibiotic treatment days from 11.4 to 7.2 per 100 near-term and term infants.…”

“…Not surprisingly, quality improvement projects often lead to an increase in quality. However, in this Issue of Acta Paediatrica , Dretvik et al present the results of their quality improvement project and report unexpected collateral benefit 6 . The aim of the interventional study was to promote discontinuing antibiotic treatment after 36‐48 hours in near‐term and term neonates with suspected, but unconfirmed, early‐onset sepsis.…”

“…The study by Dretvik et al had some limitations, because the total number of infants was relatively low and the three NICUs that were involved differed in some relevant aspects. However, the results can be taken as a plea for real‐life scenario studies 6 . A perfect, sterile study scenario might not be ideally suited to answer some of the difficult questions in infectiology.…”

C-reactive protein- and clinical symptoms-guided strategy in term neonates with early-onset sepsis reduced antibiotic use and hospital stay: a quality improvement initiative

“…Dretvik and colleagues compared the duration of antibiotic therapy in suspected EOS in three Norwegian NICUs before and after implementation of an evidence-based guideline which was developed in order to reduce unwarranted antibiotic treatment. They did not find a significant reduction in antibiotic therapy duration in neonates treated for suspected EOS but the overall antibiotic use was reduced without affecting safety [26].…”