Abstract
BackgroundAntimicrobial stewardship programs potentially lead to appropriate antibiotic use, yet the optimal approach for neonates is uncertain. Such a program was implemented in a tertiary care neonatal intensive care unit in October 2012. We evaluated the impact of this program on antimicrobial use and its association with clinical outcomes.MethodsIn a retrospective cohort study, we examined 1580 neonates who received antimicrobials in the 13-months before and 13-months during program implementation. Prospective audit and feedback was given 5 days a week on each patient who was receiving antibiotic. Pharmacy and microbiology data were linked to clinical data from the local Canadian Neonatal Network database. The primary outcome was days of antibiotic therapy per 1000 patient-days; secondary outcomes included mortality, necrotizing enterocolitis, and antibiotic duration for culture-positive and culture-negative late-onset sepsis. The breadth of antibiotic exposure was compared using the Antibiotic Spectrum Index.ResultsOverall antibiotic use decreased to 339 days of therapy per 1000 patient-days from 395 (14%, P < 0.001), without an increase in mortality. There was no difference in duration of therapy in culture-negative or culture-positive sepsis, rates of necrotizing enterocolitis, or breadth of antibiotic exposure. Fewer antibiotic starts occurred during program implementation (63% versus 59%, P < 0.001). The use of narrow-spectrum agents decreased (P < 0.001) whereas the use of cefotaxime increased (P = 0.016) during program implementation.ConclusionsDaily prospective audit and feedback was not associated with a change in antibiotic duration or clinical outcomes, however there were fewer babies started on antibiotics, suggesting that additional interventions are required to inform and sustain changes in antibiotic prescribing practices.
Highlights
Antimicrobial stewardship programs potentially lead to appropriate antibiotic use, yet the optimal approach for neonates is uncertain
Using prospective audit and feedback (PAF) as the key intervention, we prospectively evaluated antibiotic use among all babies in the neonatal intensive care unit (NICU) pre- and post-implementation of the neonatal Antimicrobial stewardship program (ASP), to: 1) Evaluate the impact of the ASP on antimicrobial use in days of therapy per 1000 patient-days, and its association with clinical outcomes, including late-onset neonatal sepsis (LONS), candidemia, necrotizing enterocolitis (NEC) and death; and
We evaluated the breadth of antibiotic exposure using the Antibiotic Spectrum Index (ASI), which classifies antibiotics according to spectrum of activity, and has been shown to be sensitive to antibiotic selection for specific conditions, as compared to days of therapy (DOT) per 1000 patient-days [29]
Summary
Antimicrobial stewardship programs potentially lead to appropriate antibiotic use, yet the optimal approach for neonates is uncertain Such a program was implemented in a tertiary care neonatal intensive care unit in October 2012. Using prospective audit and feedback (PAF) as the key intervention, we prospectively evaluated antibiotic use among all babies in the NICU pre- and post-implementation of the neonatal ASP, to: 1) Evaluate the impact of the ASP on antimicrobial use in days of therapy per 1000 patient-days, and its association with clinical outcomes, including late-onset neonatal sepsis (LONS), candidemia, NEC and death; and
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