Reducing antibiotic utilization rate in preterm infants: a quality improvement initiative

Bhat, Ramesh M; Custodio, Haidee; McCurley, Cathy; Whitehurst, Richard M; Gulati, Rashmi; Jha, Om Prakash; Bhat, Jayalakshmi; Estrada, Benjamin; Hill, Amy M.; Eyal, Fabien G.; Zayek, Michael

doi:10.1038/s41372-018-0041-y

Cited by 22 publications

(31 citation statements)

References 19 publications

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“…1,2 These risks, coupled with the diagnostic difficulties that confront neonatal practitioners, often lead to initiation and continuation of antibiotics in the absence of a clear indication. 1,3 Because mortality associated with neonatal sepsis is high, especially among preterm and very low birth weight infants, [3][4][5] it is difficult to delay or avoid antibiotic use when documented risk factors are present. However, neonatal antibiotic exposure is associated with increased risk of various adverse events, including disruption to the developing microbiome, bronchopulmonary dysplasia, necrotizing enterocolitis, late-onset sepsis, invasive candidiasis, and mortality.…”

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confidence: 99%

“…However, neonatal antibiotic exposure is associated with increased risk of various adverse events, including disruption to the developing microbiome, bronchopulmonary dysplasia, necrotizing enterocolitis, late-onset sepsis, invasive candidiasis, and mortality. 1,6,7 Despite this challenge of weighing infection risk against adverse antibiotic effects, opportunities exist for reducing the number of unnecessary antibiotic starts, decreasing duration of therapy, and improving overall judiciousness of antimicrobial use (AU) in neonates.…”

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confidence: 99%

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Using NHSN’s Antimicrobial Use Option to Monitor and Improve Antibiotic Stewardship in Neonates

O’Leary

Santen

Edwards

et al. 2019

Hospital Pediatrics

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BACKGROUND: The Antimicrobial Use (AU) Option of the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) is a surveillance resource that can provide actionable data for antibiotic stewardship programs. Such data are used to enable measurements of AU across hospitals and before, during, and after stewardship interventions. METHODS: We used monthly AU data and annual facility survey data submitted to the NHSN to describe hospitals and neonatal patient care locations reporting to the AU Option in 2017, examine frequencies of most commonly reported agents, and analyze variability in AU rates across hospitals and levels of care. We used results from these analyses in a collaborative project with Vermont Oxford Network to develop neonatal-specific Standardized Antimicrobial Administration Ratio (SAAR) agent categories and neonatal-specific NHSN Annual Hospital Survey questions. RESULTS: As of April 1, 2018, 351 US hospitals had submitted data to the AU Option from at least 1 neonatal unit. In 2017, ampicillin and gentamicin were the most frequently reported antimicrobial agents. On average, total rates of AU were highest in level III NICUs, followed by special care nurseries, level II-III NICUs, and well newborn nurseries. Seven antimicrobial categories for neonatal SAARs were created, and 6 annual hospital survey questions were developed. CONCLUSIONS: A small but growing percentage of US hospitals have submitted AU data from neonatal patient care locations to NHSN, enabling the use of AU data aggregated by NHSN as benchmarks for neonatal antimicrobial stewardship programs and further development of the SAAR summary measure for neonatal AU.

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confidence: 99%

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confidence: 99%

Using NHSN’s Antimicrobial Use Option to Monitor and Improve Antibiotic Stewardship in Neonates

O’Leary

Santen

Edwards

et al. 2019

Hospital Pediatrics

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“…Starting with the lowest baseline antibiotic consumption, Tolia et al [34] achieved a significant reduction from 99.5 to 71.7 DOT patient-days. Bhat et al [25] achieved reduction of all antibiotic utilization rates from 154.8 to 138.4 DOT. Kitano et al [27] achieved a decrease from 175.1 to 41.6 DOT.…”

Section: Resultsmentioning

confidence: 99%

“…Infants with no other risk for infections were randomized to the control or to the intervention group with 5 days of antibiotic prophylaxis. Bhat et al [25] encouraged empirical antibiotic use only in the presence of perinatal risk factors for EOS or in infants with postnatal clinical illness suggestive of evolving sepsis. Kitano et al [27] implemented comprehensive criteria for initiation of antibiotic treatment, based on maternal chorioamnionitis, infant’s clinical presentation, and laboratory values combined.…”

Section: Resultsmentioning

confidence: 99%

Antibiotic Stewardship in Premature Infants: A Systematic Review

et al. 2020

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Introduction: Antibiotic treatment in premature infants is often empirically prescribed, and practice varies widely among otherwise comparable neonatal intensive care units. Unnecessary and prolonged antibiotic treatment is documented in numerous studies. Recent research shows serious side effects and suggests long-term adverse health effects in prematurely born infants exposed to antibiotics in early life. One preventive measure to reduce unnecessary antibiotic exposure is implementation of antibiotic stewardship programs. Our objective was to review the literature on implemented antibiotic stewardship programs including premature infants with gestational age ≤34 weeks. Methods: Six academic databases (PubMed [Medline], McMaster PLUS, Cochrane Database of Systematic Reviews, UpToDate, Cochrane Central Register of Controlled Trials, and National Institute for Health and Care Excellence) were systematically searched. PRISMA guidelines were applied. Results: The search retrieved 1,212 titles of which 12 fitted inclusion criteria (11 observational studies and 1 randomized clinical trial). Included articles were critically appraised. We grouped the articles according to common area of implemented stewardship actions: (1) focus on reducing initiation of antibiotic therapy, (2) focus on shortening duration of antibiotic therapy, (3) various organizational stewardship implementations. The heterogeneity of cohort composition, of implemented actions and of outcome measures made meta-analysis inappropriate. We provide an overview of the reduction in antibiotic use achieved. Conclusion: Antibiotic stewardship programs can be effective for premature newborns especially when multifactorial and tailored to this population, focusing on reducing initiation or on shortening the duration of antibiotic therapy. Programs without specific measures were less effective.

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“…Furthermore, although there is undoubtedly daily, weekly, and monthly variation in AUR, the 4 cross-sectional assessments provide a consistent trend in AUR reduction, which is also supported by the observation of center-specific AURs submitted as abstracts to the VON Annual Quality Congress (VON, personal communication, 2018), as well as recent publications from centers participating in the collaborative. [36][37][38] Third, there is a lack of a balancing measure(s) at the collaborative level, although all of the NICUs were encouraged to develop one(s) as part of their local work, which reflected the local context of their project. Typical balancing measures for antibiotic stewardship can include increase in infections and mortality and other morbidities as a result of undertreatment.…”

Section: Discussionmentioning

confidence: 99%

A Collaborative Multicenter QI Initiative to Improve Antibiotic Stewardship in Newborns

et al. 2019

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OBJECTIVES: To determine if NICU teams participating in a multicenter quality improvement (QI) collaborative achieve increased compliance with the Centers for Disease Control and Prevention (CDC) core elements for antibiotic stewardship and demonstrate reductions in antibiotic use (AU) among newborns. METHODS: From January 2016 to December 2017, multidisciplinary teams from 146 NICUs participated in Choosing Antibiotics Wisely, an Internet-based national QI collaborative conducted by the Vermont Oxford Network consisting of interactive Web sessions, a series of 4 pointprevalence audits, and expert coaching designed to help teams test and implement the CDC core elements of antibiotic stewardship. The audits assessed unit-level adherence to the CDC core elements and collected patient-level data about AU. The AU rate was defined as the percentage of infants in the NICU receiving 1 or more antibiotics on the day of the audit. RESULTS: The percentage of NICUs implementing the CDC core elements increased in each of the 7 domains (

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Reducing antibiotic utilization rate in preterm infants: a quality improvement initiative

Abstract: This multiphase QI initiative was able to reduce the overall AUR at our NICU. The beneficial impact of this decrease in AUR in preterm infants remains to be determined.

Cited by 22 publications

References 19 publications

Using NHSN’s Antimicrobial Use Option to Monitor and Improve Antibiotic Stewardship in Neonates

Using NHSN’s Antimicrobial Use Option to Monitor and Improve Antibiotic Stewardship in Neonates

Antibiotic Stewardship in Premature Infants: A Systematic Review

A Collaborative Multicenter QI Initiative to Improve Antibiotic Stewardship in Newborns

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