Reduction of unnecessary antibiotic days in a level IV neonatal intensive care unit

Abstract

Objective: Antibiotics are widely prescribed in the neonatal intensive care unit (NICU) and duration of prescription is varied. We sought to decrease unnecessary antibiotic days for the most common indications in our outborn level IV NICU by 20% within 1 year. Design and interventions: A retrospective chart review was completed to determine the most common indications and treatment duration for antibiotic therapy in our 39-bed level IV NICU. A multidisciplinary team was convened to develop an antibiotic stewardship quality improvement initiative with new consensus guidelines for antibiotic duration for these common indications. To optimize compliance, prospective audit was completed to ensure antibiotic stop dates were utilized and provider justification for treatment duration was documented. Multiple rounds of educational sessions were conducted with neonatology providers. Results: In total, 262 patients were prescribed antibiotics (139 in baseline period and 123 after the intervention). The percentage of unnecessary antibiotic days (UAD) was defined as days beyond the consensus guidelines. As a balancing measure, reinitiation of antibiotics within 2 weeks was tracked. After sequential interventions, the percentage of UAD decreased from 42% to 12%, which exceeded our goal of a 20% decrease. Compliance with antibiotic stop dates increased from 32% to 76%, and no antibiotics were reinitiated within 2 weeks. Conclusions: A multidisciplinary antibiotic stewardship team coupled with a consensus for antibiotic therapy duration, prescriber justification of antibiotic necessity and use of antibiotic stop dates can effectively reduce unnecessary antibiotic exposure in the NICU.

New strategies to Reduce Unnecessary Antibiotic Use in the NICU: A Quality Improvement Initiative

“… 35 , 36 Furthermore, guiding therapy by repeated CRP determinations may result in further unnecessary investigations, increased lumbar punctures, longer durations of antibiotic treatment, and hospitalization. 37 Sixth, acknowledging the benefits associated with the daily participation of a NICU pharmacist in multidisciplinary rounds in similar projects, 38 our NICU pharmacist was present in multidisciplinary rounds 7 days a week. Seventh, we continued to report on the sustainability of our project 36 months after the completion of our initial QI project goal.…”