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NICU surveillance generates antibiotic stewardship interventions
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Joseph B. Cantey
An examination of antibiotic consumption in a neonatal ICU in a Texas hospital provided high-yield stewardship targets that allowed for interventions to reduce antibiotic use, according to recent research.
“The beneficial effects of antibiotic therapy when indicated are unquestioned,” Joseph B. Cantey, MD, of the department of pediatrics at the University of Texas Southwestern Medical Center, and colleagues wrote. “However, the overuse of antibiotics in neonatal intensive care units has been associated with adverse outcomes, including increased risk for infection with multidrug-resistant organisms, invasive candidosis, bronchopulmonary dysplasia, necrotizing enterocolitis, late-onset sepsis and death.”
The researchers conducted the Surveillance and Correction of Unnecessary Antibiotic Therapy (SCOUT) study to evaluate all antibiotic use in infants admitted to the level 3 NICU at Parkland Hospital in Dallas from March 2012 through November 2012. Infants (n = 2,502) aged younger than 35 weeks’ gestational age or less than 2,100 g at birth were admitted during the baseline (October 2011 through November 2012; n = 1,607) and intervention (October 2013 through June 2014; n = 895) periods. The researchers considered antibiotic stewardship interventions after the baseline period in cases where continued empirical antibiotic therapy for pneumonia, “culture-negative” sepsis and ruled-out sepsis courses extended past 48 hours. Empirical antibiotic therapy was discontinued in infants after 48 hours, and pneumonia and culture-negative sepsis therapy was restricted to 5 days during the intervention period. The researchers compared antibiotic use (therapy per 1,000 patient-days) within both periods.
Analyses showed a decrease in antibiotic use from 342.2 days of therapy per 1,000 patient-days during the baseline period to 252.2 days per 1,000 patient-days in the intervention period (P < .0001), resulting in an overall reduction of 27%. No significant differences in safety outcomes were observed between study periods.
“Overall, our study shows that antibiotic stewardship in the [NICU] can be achieved safely,” Cantey and colleagues wrote. “By thoroughly assessing all antibiotic use, we were able to establish which clinical scenarios were most amenable to stewardship interventions, design specific interventions to target those areas, and then track both subsequent antibiotic use and safety outcomes.
“These findings support an overall increase in appropriate antibiotic usage in our [NICU].” – by Kate Sherrer
Disclosure: The researchers report no relevant financial disclosures.
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