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Stewardship reduces use of 2-day antibiotic courses among newborns

BALTIMORE — Data presented at the Pediatric Academic Societies Meeting showed that prophylactic antibiotic stewardship reduced the use of 2-day therapy courses by 18% for all newborns already receiving antibiotics in a Tennessee neonatal ICU.

“Prophylactic antibiotics for neonates are justified in situations of high-risk peripartum milieu,” researchers from the University of Tennessee Health Science Center and Regional One Health wrote. “Neonates with clinical symptoms of sepsis and/or abnormal laboratory values may be continued on antibiotics beyond the empirical 48-hour mark of sterile cultures. However, antimicrobial therapy in infants without other indications should be promptly discontinued.”

In a 2013 study, the researchers found that antibiotics were extended beyond 48 hours for the majority of cases at their NICU. To eliminate unnecessary treatment, the researchers implemented antibiotic stewardship for courses longer than 48 hours. To evaluate their stewardship, the researchers performed a retrospective chart review of 202 newborns in 2015, excluding infants with meningitis. The researchers compared clinical and demographic data from this cohort with data collected from 218 newborns in 2013.

The mean duration of antibiotic therapy was 88 hours and 52 minutes in 2013 vs. 77 hours and 55 minutes in 2015 (P = .008). In 2013, 85% of newborns received antibiotic courses longer than 48 hours, while 67% received these prolonged courses in 2015 (P < .001). The physicians indicated in their notes that 24% of the 2015 group with longer than 2-day therapy had a delayed discontinuation order that led to the prolonged course. In 2013, the physicians documented no reason for discontinuation for 30% of newborns, while in 2015 nondocumented reasons occurred in 4% of cases (P <.001). The documented reasons for continuation included clinical symptoms, elevated C-reactive protein and chorioamnionitis.

“Antibiotics monitoring and stewardship reduced the use of more than 48-hour antibiotics with a significant improvement in documentation for the need of antibiotics,” the researchers wrote. “Continuation of antibiotics in the face of abnormal lab values in asymptomatic infants should also be re-evaluated.” – by Will Offit

Reference:

Thoni N, et al. Abstract 1530.677. Presented at: Pediatric Academic Societies Meeting; April 30-May 3, 2016; Baltimore.

Disclosure: Infectious Diseases in Children was unable to confirm relevant financial disclosures at the time of publication.