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48-hour autostop order effectively decreases antibiotic use in NICU
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An electronic 48-hour automatic stop for antibiotic orders within the neonatal ICU admission order set decreased antibiotic use in infants, according to research published in the Journal of the Pediatric Infectious Diseases Society.
“Antibiotics are the most prescribed medications in the NICU,” Maria Corazon Astorga, MD, a neonatologist in the pediatrics department, University of Wisconsin-Madison, and colleagues wrote. “Deciding on the duration of antibiotic therapy is a common clinical dilemma, and practices vary on the basis of provider judgment, risks and benefits, clinical management algorithms, and/or availability for close monitoring of patient status to identify an infectious diagnosis.”
The researchers noted that because of the lack of specificity of clinical signs of sepsis, it is common for antibiotics to be given for 48 hours in a neonatal ICU (NICU) pending culture results and clinical status.
Astorga and colleagues conducted an observational, double-cohort study of the NICU at UnityPoint health-Meriter Hospital, Madison, Wisconsin. The researchers measured antibiotic use before and after the implementation of an electronic 48-hour automatic stop (autostop) on all antibiotic orders within the NICU admission order set, including ampicillin and gentamicin.
The preintervention cohort consisted of 564 neonates, and the postintervention cohort had 639 neonates. Maternal or fetal characteristics did not differ between the groups.
When the autostop intervention was implemented, antibiotic doses per patient decreased by 35% for all five parenteral antibiotics included in the study and by 25% in doses per patient-day (P < .0001, both).
Vancomycin had the largest percentage decrease (66%) and cost estimate decrease (36.7%) among the five antibiotics when the intervention was implemented.
The researchers noted that when providers had high suspicion of sepsis in infants, they proactively continued antibiotics. Infants with positive blood or cerebrospinal fluid cultures also received antibiotics.
“Using the [electronic health record] as a tool for antibiotic stewardship is effective for achieving the goal of decreasing unnecessary antibiotic doses,” the researchers concluded. “Incorporating additional interventions, such as using the Kaiser sepsis risk calculator and time outs at 24 to 36 hours, could decrease exposure further in select patients at lowest risk.” – by Bruce Thiel
Disclosures: The authors report no relevant financial disclosures.
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