1506. Outcomes of Standardized Neonatal Cephalexin Dosing

Abstract

BackgroundThe optimal dosing of cephalexin in infants ≤90 days old is not well known. Our Antimicrobial Stewardship Program (ASP) standardized cephalexin dosing for inpatients ≥30 days old using available literature and released an antimicrobial dosing guideline in September 2016. Recommended antimicrobial dosing for inpatients <30 days old followed in November 2017. We reviewed the indications, cephalexin dosing, and clinical outcomes of patients before and after the release of our ASP’s cephalexin dosing guidelines.MethodsWebi Universe was queried for cephalexin orders for inpatients ≤ 90 days old at the Inova Children’s Hospital from January 2016 to November 2018. Manual chart review extracted clinical points of interest and ensured that inclusion criteria were met. For patients <30 days old, the pre-intervention period was January 2016 to October 2017 and the post-intervention period was November 2017 to October 2018. For patients ≥30 days old the pre-intervention period was January 2016 to August 2016 and the post-intervention period was September 2016 to October 2018. Aggregate data from the two pre-intervention and two post-intervention periods were pooled, respectively.Results41 patients were identified: 25 in the pre-intervention period and 16 in the post-intervention period. The median age of patients in the pre-intervention period was 16 days compared with 31 days in the post-intervention period (P = 0.02). No patients had acute kidney injury requiring cephalexin renal dosing. Skin and soft-tissue infections (18) and urinary tract infections (10) were the most common infections in both periods. 24% of patients received the recommended cephalexin dose in the pre-intervention period compared with 63% in the post-intervention period (P = 0.02). Logistic regression controlling for pathogens and area of care showed that patient age predicted the use of recommended cephalexin dosing (OR 1.1, 95% CI: 1.01–1.21). There were no deaths or recrudescent infections.ConclusionOur ASP’s interventions improved adherence to standardized cephalexin dosing in inpatients ≤90 days old without any adverse clinical outcomes. Patients ≥30 days old were more likely to receive recommended cephalexin dosing. Opportunities remain to best define the optimal dose of cephalexin in infants ≤90 days old.Disclosures All authors: No reported disclosures.