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NICU Antibiotic Use Guidelines Reduce Late-onset Sepsis in Infants

While hospitals increasingly have antibiotic stewardship guidelines for various departments, those remain rare in neonatal ICUs (NICUs), according to a new study.

The report in Infection Control & Hospital Epidemiology discusses the effects of an effort to reduce variability in treating common infections and improving clinical adherence to best practice at the Yale University School of Medicine NICU.

The researchers found that the efforts significantly reduced the number of cases of late-onset sepsis, which is a leading cause of death among preterm infants.

"It can be difficult to distinguish infections from other disease symptoms in preterm infants. Timely interventions for a true infection are critical, but unnecessary exposures to antibiotics can result in antimicrobial resistance, increased risk for serious health conditions, or even death," explained lead author Nneka Nzegwu, DO, attending physician in neonatal-perinatal medicine at Brigham and Women's Hospital in Boston. "We are encouraged that antimicrobial stewardship in the NICU is gaining focus and attention. Our hope is that our experience assists others on a similar journey."

The antibiotic stewardship program was developed by a multidisciplinary team. It included the following features:

  • clinical guidelines published to the hospital-based intranet to curtail provider-to-provider variability in prescriptions;
  • a unit-wide educational effort to introduce the principles of stewardship, review guidelines, and present outcomes measures;
  • review of a daily report based on electronic medical records by stewardship team members, providing timely prescriber oversight and feedback.

Results indicate that healthcare-associated infections decreased, including evaluations for late-onset sepsis, with an average reduction of 2.65 late-onset sepsis evaluations per year and per provider. In 2011, the year before the stewardship program implementation, the NICU had an average of 21.2 late-onset sepsis evaluations per 100 days, which decreased to 8.4 evaluations by 2016.

Adherence was very high. Clinical guidelines for prescribing antibiotics were followed by physicians 98.75% of the time. The results? No infants with clinical infections developed a recurrent infection after seven days of discontinuing their antibiotic treatment.

"So few antimicrobial stewardship programs provide NICU-specific guidelines to cut down on unnecessary prescription practices," added co-author Matthew Bizzarro, MD, medical director of the NICU at Yale-New Haven Children's Hospital. "Our use of an electronic medical record-generated daily report, with additional information on the rationale behind each prescription event, was somewhat novel and incredibly useful in providing timely feedback and review of prescriber practices."