264. Simple and Feasible NICU Antimicrobial Stewardship Program in a Japanese Community Hospital

Abstract

BackgroundAntimicrobial stewardship programs (ASP) have been implemented in many hospitals, including NICU departments. Although tertiary hospitals have successfully introduced ASPs by antimicrobial stewardship teams, lots of community hospitals without pediatric infectious disease specialists have difficulty implementing ASP. We present a successful implementation of simple and feasible NICU antimicrobial stewardship program in a Japanese community hospital.MethodsWe developed a protocol of antimicrobial treatment in the NICU department of Nara Prefecture General Medical Center, Nara, Japan and have implemented it from September 2017. The protocol consists of antimicrobial treatment criteria (criteria for starting antimicrobials for neonates with suspected early-onset infection, criteria of prolonged antimicrobial treatment for more than 48 hours and duration of treatment), weekend report of blood culture result from microbiology department and stopping ordering antimicrobials beforehand for the next day. We compared days of therapy (DOT) during the post-implementation period (September 2017 to March 2018) with that of the pre-implementation period (March 2013 to August 2017).ResultsDuring the pre- and post-ASP implementations, 913 and 92 patients were admitted to NICU. Mean DOT/1,000 patient-days were 217.9 and 56.6 in pre- and post-ASP implementations (P < 0.001) with 74.0% reduction of antimicrobial prescriptions. Mortality rates were 0.4% and 0.0% (P = 0.54), and 4.6% and 5.3% of patients had sepsis (P = 0.76), respectively. Weekend reports of blood culture result were performed in six patients and shortened their length of antimicrobial treatment during the post-ASP implementation period.ConclusionThis ASP program was easily implemented in a NICU department of a community hospital and significantly reduced antimicrobial prescription. This kind of simple protocol may be successfully scaled-up in resource limited community hospitals without any pediatric infectious disease specialists or antimicrobial stewardship teams.Disclosures All authors: No reported disclosures.