Antimicrobial Stewardship in a Tertiary Neonatal Intensive Care Unit with Limited Resources

Fouzia Naeem,Brenik Kuzmic,Ashley Thomas,Indira Chandrasekar

doi:10.11648/j.ajp.20200603.30

Abstract

Background: Antimicrobial stewardship programs (ASP) have been recognized nationally as an effective way to combat antimicrobial resistance. Using data from the Pediatric Health Information System (PHIS) database, we noticed high utilization of antimicrobials in our hospital particularly in our tertiary level neonatal intensive care unit (NICU). This prompted focused efforts in the NICU consisting of development of management guidelines and prospective audit with intervention and feedback. Method: Using the PHIS database, we retrospectively measured days of therapy per 1000 patient days (DOT/1000 PD) in the NICU during the pre-implementation, implementation and post-implementation phases to determine the change in antimicrobial utilization. All antimicrobials administered between 01/01/14 to 12/31/19 were included in this review. Secondary outcomes including late-onset sepsis (LOS), necrotizing enterocolitis (NEC), mortality rates and hospital-wide antimicrobial utilization were also evaluated. Comparison of means among groups was performed by analysis of variance (ANOVA). Results: Overall, mean DOT/1000 PD for the NICU decreased 32% from the pre-implementation to the post-implementation phase (656.86 vs 480.81 vs 431.90 DOT/1000 PD, P < 0.01). NICU LOS rates decreased from 2.4% to 1.5%. NEC and mortality rates remained unchanged from 4.2% to 4.9% and 3.4% to 4.4%, respectively. Mean DOT/1000 PD for the entire hospital decreased 22% overall (857.09 vs 739.71 vs 667.76 DOT/1000 PD, P < 0.01). Conclusions: Implementation of a NICU ASP helped reduce antimicrobial utilization in the NICU without increasing morbidity and mortality. Hospitals with limited resources may consider targeted unit-based stewardship to help reduce antimicrobial utilization.

Highlights

Antibiotics are one of the most commonly prescribed medication in a Neonatal Intensive Care Unit (NICU) internationally. [1, 2]
Hospital-wide the mean days of therapy (DOT) per 1000 patient days (PD) decreased by 22% from the preimplementation to post-implementation phase (857.09 vs 667.76, P < 0.01; Figure 1)
Individual antibiotic assessment found a decrease in vancomycin use by 42% (69.87 vs 43.28 vs 40.18 DOT/1000 PD, P < 0.01), ampicillin by 36% (182.68 vs 134.08 vs 116.14, P < 0.01), gentamicin by 49% (176.96 vs 119.19 vs 90.8, P < 0.01), metronidazole by 61% (18.24 vs 5.43 vs 7.12, P < 0.01), and meropenem by 30% (7.12 vs 9.38 vs 5.01, P < 0.19) (Figure 2)

Summary

Introduction

Antibiotics are one of the most commonly prescribed medication in a Neonatal Intensive Care Unit (NICU) internationally. [1, 2]. The California Children’s Services and California Perinatal Quality Care Collaborative (CPQCC) reported a 40-fold variation in antibiotic use rates (AURs) It ranging from 2.4% to 97% of patient days, in a combined data set from 2013. Using data from the Pediatric Health Information System (PHIS) database, we noticed high utilization of antimicrobials in our hospital in our tertiary level neonatal intensive care unit (NICU). This prompted focused efforts in the NICU consisting of development of management guidelines and prospective audit with intervention and feedback. Secondary outcomes including late-onset sepsis (LOS), necrotizing enterocolitis (NEC), mortality rates and hospital-wide antimicrobial utilization were evaluated. Hospitals with limited resources may consider targeted unit-based stewardship to help reduce antimicrobial utilization

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Conclusion