August 03, 2017
2 min read

Antimicrobial stewardship program feasible, effective in NICU

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Implementing an antimicrobial stewardship program in a NICU is feasible and improves antibiotic prescription practices, according to findings from a recently published study.

“It can be difficult to distinguish infections from other disease symptoms in pre-term infants. Timely interventions for a true infection are critical, but unnecessary exposures to antibiotics can result in antimicrobial resistance, increased risk for serious health conditions, or even death,” Nneka Nzegwu, DO, attending physician in neonatal-perinatal medicine at Brigham and Women’s Hospital, said in a press release. “We are encouraged that antimicrobial stewardship in the NICU is gaining focus and attention. Our hope is that our experience assists others on a similar journey.”

Nzegwu and colleagues performed a quasi-experimental, interrupted time-series study in a level 4 NICU at an academic and tertiary referral center, reviewing information on all newborns who were prescribed antibiotics between Jan. 1, 2011, and June 30, 2016. The researchers launched a new antimicrobial stewardship program (ASP) at the center on May 1, 2013. The main outcome was the number of days of antibiotic therapy per 1,000 patient-days, with provider-specific antimicrobial prescription events for late-onset sepsis and guideline compliance as secondary outcomes.

Use of antibiotics fell by 14.7 days of therapy per 1,000 patient-days under the stewardship program, Nzegwu and colleagues reported, although they added that the decrease was not statistically significant. However, prescriptions of ampicillin, the unit’s most commonly prescribed antimicrobial, decreased significantly (22.5 days of therapy per 1,000 patient-days; P = .037).

Nzegwu and colleagues reported that late-onset sepsis evaluation and prescription events per 100 patient-days both fell significantly from 21.2 evaluations per 100 days in 2011 to 8.4 evaluations per 100 days in 2016 (mean reduction, 2.65 evaluations per year per provider; P < .0001).

Physicians adhered to clinical guidelines in 98.75% of treatment courses during the stewardship period, the researchers wrote.

“Our success is likely multifactorial, but we believe a key component was prospective audit and feedback to (and from) the prescriber,” Nzegwu and colleagues wrote. “There has recently been a great deal of increased attention and resources allocated to the reduction of inappropriate antibiotic use on a national level, including international collaborative efforts among NICUs. Our efforts, as well as the overall reduction in antimicrobial utilization observed among NICUs in the Pediatric Health Information System, may exemplify a growing awareness that ASPs have the potential to not only reduce antibiotic overuse and misuse but also to impact common neonatal morbidities and mortality faced by these extremely vulnerable infants.” – by Andy Polhamus

Disclosure: The researchers report no relevant financial disclosures.