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Flannery DD, Zevallos Barboza A, Mukhopadhyay S, Gerber JS, McDonough M, Shu D, Hennessy S, Wade KC, Puopolo KM. Antibiotic use among extremely low birth-weight infants from 2009 to 2021: a retrospective observational study. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326734. [PMID: 39033026 DOI: 10.1136/archdischild-2023-326734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 06/20/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE To assess trends in antibiotic use across a large cohort of extremely low birth-weight (<1000 g; ELBW) infants admitted to academic and community neonatal intensive care units (NICUs) across the USA over a 13-year period. DESIGN Repeated cross-sectional cohort study. SETTING Premier Health Database, a comprehensive administrative database of inpatient encounters from academic and community hospitals across the US. PATIENTS ELBW inborn infants admitted to NICUs from 1 January 2009 to 31 December 2021. INTERVENTIONS N/A MAIN OUTCOME MEASURES: Absolute and relative changes in (1) proportion of ELBW infants with antibiotic exposure and (2) days of therapy (DOT) per 1000 patient days, over time. Average annual differences were estimated using generalised linear regression with 95% CI. Disposition trends were also measured. RESULTS Among 36 701 infants admitted to 402 NICUs, the proportion exposed to antibiotics was essentially unchanged (89.9% in 2009 to 89.3% in 2021; absolute reduction of -0.6%); generalised linear regression estimated an annual absolute difference of -0.3% (95% CI (-0.6%) to (-0.07%); p=0.01). DOT per 1000 patient days decreased from 337 in 2009 to 210 in 2021, a 37.8% relative difference and annual relative difference of -4.3% ((-5.2%) to (-3.5%); p<0.001). Mortality was unchanged during the study period. CONCLUSIONS We found a substantial reduction in antibiotic DOT despite no substantive change in the proportion of infants exposed to antibiotics. This suggests the success of stewardship efforts aimed at antibiotic duration and highlight the need for improved approaches to identifying ELBW infants at highest risk of infection.
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Affiliation(s)
- Dustin D Flannery
- Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Sagori Mukhopadhyay
- Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey S Gerber
- Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Molly McDonough
- Center for Healthcare Quality & Analytics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Di Shu
- Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sean Hennessy
- Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kelly C Wade
- Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karen M Puopolo
- Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Quan MY, Feng SJ, Zhang Y, Wang C, Zhang LJ, Li ZH. [A quality improvement project on reducing antibiotic use duration in very low birth weight preterm infants in the neonatal intensive care unit]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:736-742. [PMID: 39014951 DOI: 10.7499/j.issn.1008-8830.2311037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
OBJECTIVES To develop effective measures to reduce antibiotic use duration in very low birth weight (VLBW) preterm infants in the neonatal intensive care unit through quality improvement methods. METHODS The study population consisted of hospitalized VLBW preterm infants, with the percentage of hospitalization time during which antibiotics were used from November 2020 to June 2021 serving as the baseline. The specific quality improvement goal was to reduce the duration of antibiotic use. Factors affecting antibiotic use duration in preterm infants were analyzed using Pareto charts. Key drivers were identified, and specific interventions were formulated based on the stages of antibiotic use. Changes in the percentage of antibiotic use duration were monitored with run charts until the quality improvement target was achieved. RESULTS From November 2020 to June 2021, the baseline antibiotic use duration percentage was 49%, with a quality improvement target to reduce this by 10% within 12 months. The Pareto analysis indicated that major factors influencing antibiotic duration included non-standard antibiotic use; delayed cessation of antibiotics when no infection evidence was present; prolonged central venous catheter placement; insufficient application of kangaroo care; and delayed progress in enteral nutrition. The interventions implemented included: (1) establishing sepsis evaluation and management standards; (2) educating medical staff on the rational use of antibiotics for preterm infants; (3) supervising the enforcement of antibiotic use standards during ward rounds; (4) for those without clear signs of infection and with negative blood cultures, discontinued the use of antibiotics 36 hours after initiation; (5) reducing the duration of central venous catheterization and parenteral nutrition to lower the risk of infection in preterm infants. The control chart showed that with continuous implementation of interventions, the percentage of antibiotic use duration was reduced from 49% to 32%, a statistically significant decrease. CONCLUSIONS The application of quality improvement tools based on statistical principles and process control may significantly reduce the antibiotic use duration in VLBW preterm infants. Citation:Chinese Journal of Contemporary Pediatrics, 2024, 26(7): 736-742.
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Affiliation(s)
- Mei-Ying Quan
- Department of Pediatrics, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Shu-Ju Feng
- Department of Pediatrics, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Yu Zhang
- Department of Pediatrics, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Chen Wang
- Department of Pediatrics, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Le-Jia Zhang
- Department of Pediatrics, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Zheng-Hong Li
- Department of Pediatrics, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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Agudelo-Pérez S, Moreno AM, Martínez-Garro J, Salazar J, Lopez R, Perdigón M, Peláez R. 16S rDNA Sequencing for Bacterial Identification in Preterm Infants with Suspected Early-Onset Neonatal Sepsis. Trop Med Infect Dis 2024; 9:152. [PMID: 39058194 PMCID: PMC11281265 DOI: 10.3390/tropicalmed9070152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/18/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The high prevalence of suspected early-onset neonatal sepsis among preterm infants leads to immediate antibiotic administration upon admission. Notably, most blood cultures for suspected early-onset neonatal sepsis do not yield a causative pathogen. This study aimed to assess polymerase chain reaction (PCR) targeting the variable region V4 of the 16S ribosomal gene (16S rDNA) and Sanger sequencing for bacterial identification in preterm infants with suspected early-onset neonatal sepsis. METHODS Therefore, this prospective study was conducted. Preterm infants with suspected early-onset neonatal sepsis were included in this study. The three groups were formed based on the risk of infection and clinical sepsis. Blood samples were collected upon admission to the neonatal unit for culture and molecular analysis. PCR amplification and subsequent Sanger sequencing of the V4 region of the 16S rDNA were performed. RESULTS Twenty-eight patients were included in this study. Blood cultures were negative in 100% of the patients. Amplification and sequencing of the V4 region identified bacterial genera in 19 patients across distinct groups. The predominant taxonomically identified genus was Pseudomonas. CONCLUSIONS Amplifying the 16S rDNA variable region through PCR and subsequent Sanger sequencing in preterm neonates with suspected early-onset neonatal sepsis can enhance the identification of microbial species that cause infection, especially in negative cultures.
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Affiliation(s)
- Sergio Agudelo-Pérez
- Department of Pediatrics, Faculty of Medicine, Universidad de La Sabana, Chía 025001, Colombia;
| | - A. Melissa Moreno
- Faculty of Science and Biotechnology, Universidad CES, Medellin 050022, Colombia; (A.M.M.); (J.M.-G.)
| | - Juliana Martínez-Garro
- Faculty of Science and Biotechnology, Universidad CES, Medellin 050022, Colombia; (A.M.M.); (J.M.-G.)
| | - Jorge Salazar
- Research Center, Grupo de Estudio de Enfermedades Infecciosas y Crónicas (GEINCRO), San Martin University Foundation, Sabaneta 055450, Colombia;
| | - Ruth Lopez
- Neonatal Unit, Hospital Meissen, Bogotá 111711, Colombia;
| | - Mateo Perdigón
- Department of Pediatrics, Faculty of Medicine, Universidad de La Sabana, Chía 025001, Colombia;
| | - Ronald Peláez
- Graduate School, Universidad CES, Medellin 050022, Colombia;
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Mascarenhas D, Ho MSP, Ting J, Shah PS. Antimicrobial Stewardship Programs in Neonates: A Meta-Analysis. Pediatrics 2024; 153:e2023065091. [PMID: 38766702 DOI: 10.1542/peds.2023-065091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Neonatal sepsis is a significant contributor to mortality and morbidity; however, the uncontrolled use of antimicrobials is associated with significant adverse effects. Our objective with this article is to review the components of neonatal antimicrobial stewardship programs (ASP) and their effects on clinical outcomes, cost-effectiveness, and antimicrobial resistance. METHODS We selected randomized and nonrandomized trials and observational and quality improvement studies evaluating the impact of ASP with a cutoff date of May 22, 2023. The data sources for these studies included PubMed, Medline, Embase, Cochrane CENTRAL, Web of Science, and SCOPUS. Details of the ASP components and clinical outcomes were extracted into a predefined form. RESULTS Of the 4048 studies retrieved, 70 studies (44 cohort and 26 observational studies) of >350 000 neonates met the inclusion criteria. Moderate-certainty evidence reveals a significant reduction in antimicrobial initiation in NICU (pooled risk difference [RD] 19%; 95% confidence interval [CI] 14% to 24%; 21 studies, 27 075 infants) and combined NICU and postnatal ward settings (pooled RD 8%; 95% CI 6% to 10%; 12 studies, 358 317 infants), duration of antimicrobial agents therapy (pooled RD 20%; 95% CI 10% to 30%; 9 studies, 303 604 infants), length of therapy (pooled RD 1.82 days; 95% CI 1.09 to 2.56 days; 10 studies, 157 553 infants), and use of antimicrobial agents >5 days (pooled RD 9%; 95% CI 3% to 15%; 5 studies, 9412 infants). Low-certainty evidence reveals a reduction in economic burden and drug resistance, favorable sustainability metrices, without an increase in sepsis-related mortality or the reinitiation of antimicrobial agents. Studies had heterogeneity with significant variations in ASP interventions, population settings, and outcome definitions. CONCLUSIONS Moderate- to low-certainty evidence reveals that neonatal ASP interventions are associated with reduction in the initiation and duration of antimicrobial use, without an increase in adverse events.
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Affiliation(s)
- Dwayne Mascarenhas
- Neonatal-Perinatal Medicine Fellowship Training Program, University of Toronto, Toronto, Ontario
- Department of Pediatrics, Sinai Health System, Toronto, Ontario
- Department of Pediatrics, University of Toronto, Ontario
| | | | - Joseph Ting
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Prakesh S Shah
- Department of Pediatrics, Sinai Health System, Toronto, Ontario
- Department of Pediatrics, University of Toronto, Ontario
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Singh HP, Wilkinson S, Kamran S. Decreasing Antibiotic Use in a Community Neonatal Intensive Care Unit: A Quality Improvement Initiative. Am J Perinatol 2024; 41:e2767-e2775. [PMID: 37607590 PMCID: PMC11150059 DOI: 10.1055/a-2158-8422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/16/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE In view of the excessive use of antibiotics in our neonatal intensive care unit (NICU), we launched a 5-year multidisciplinary quality improvement (QI) initiative in our NICU in 2018. We had set our aim of decreasing the antibiotic use rate (AUR) from 22 to 17%. STUDY DESIGN The QI initiative was conducted in our 53-bed level 3B NICU. We used the core elements of antibiotic stewardship and focused on improving gaps in knowledge by using updated standards of care and a multidisciplinary approach. Outcome measures included overall AUR in NICU. Statistical control chart (P chart) was used to plot the AUR data quarterly. RESULTS The AUR demonstrated a decline at the onset, and at the end of the initiative the AUR demonstrated a sustained decline to 13.18%, a 40% decrease from the baseline AUR of 22%. The changes that were implemented included development of evidence-based guidelines for babies less than and greater than 35 weeks, daily antibiotic stewardship rounds, sepsis risk calculator, antibiotic stop orders (48-hour stop, 36-hour soft stop, and 36-hour hard stop), and periodic reviews. CONCLUSION Our multidisciplinary approach using all the core elements of an antibiotic stewardship program significantly decreased AUR in our NICU. KEY POINTS · Excessive use of antibiotics may cause harm to the infant's health.. · Indiscriminate use of antibiotics can lead to antibiotic resistance.. · Stewardship programs can significantly decrease AUR in NICUs..
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Affiliation(s)
- Harjinder P. Singh
- Division of Neonatology, Pomona Valley Hospital Medical Center, Pomona, California
| | - Susan Wilkinson
- Division of Neonatology, Pomona Valley Hospital Medical Center, Pomona, California
| | - Shahid Kamran
- Division of Neonatology, Pomona Valley Hospital Medical Center, Pomona, California
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Grace E, Jayakumar N, Cooper C, Andersen C, Callander E, Gomersall J, Rumbold A, Keir A. Reducing intravenous antibiotics in neonates born ≥35 weeks' gestation: A quality improvement study. J Paediatr Child Health 2024; 60:139-146. [PMID: 38695518 DOI: 10.1111/jpc.16537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 09/21/2023] [Accepted: 03/18/2024] [Indexed: 05/19/2024]
Abstract
AIM To assess the impact of the Early Onset Sepsis (EOS) calculator, implemented as a quality improvement study, to reduce the rate of unnecessary antibiotics in neonates born ≥35 weeks' gestation. METHODS An audit of routinely collected hospital data from January 2008 to March 2014 (retrospective) and from January 2018 to September 2019 (prospective) determined baseline incidence of EOS intravenous antibiotic use in neonates born ≥35 weeks' gestation in a tertiary level perinatal centre. Plan-do-study-act (PDSA) cycles were applied to implement the EOS calculator. Statistical process control methodology and time series analysis assessments were used to assess the potential impact of the PDSA cycles on the rate of intravenous antibiotics, blood culture collection, EOS, length of stay and health care costs (not adjusted for potential confounders). RESULTS In the study population, from January 2008 to March 2014, the baseline incidence of intravenous antibiotic use was 10.49% (2970/28290), whilst only 0.067% (19/28290) neonates had culture proven EOS. From January 2018 to October 2019, prior to implementation of the EOS calculator, 13.3% (1119/8411) neonates were treated with intravenous antibiotic and the use decreased to 8.3% (61/734) post-implementation. The rate of blood culture collection decreased from 14.4% (1211/8411) to 11.9% (87/734). There were no cases of missed EOS. Length of stay decreased from 2.68 to 2.39 days, with an estimated cost saving of $366 per patient per admission. CONCLUSION Implementing the EOS calculator in a tertiary hospital setting reduced invasive investigations for EOS and intravenous antibiotic use among neonates ≥35 weeks' gestation. This can result in reduced length of neonatal hospital stays, and associated health care cost savings and may reduce separation of mother and baby.
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Affiliation(s)
- Erin Grace
- Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia
- Department of Paediatrics, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
| | - Nilarni Jayakumar
- Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Celia Cooper
- Department of Infectious Diseases, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Chad Andersen
- Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Emily Callander
- Monash Centre for Health Research and Implementation, School of Public Health, Monash University, Melbourne, Victoria, Australia
| | - Judith Gomersall
- Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Alice Rumbold
- Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
- Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia
| | - Amy Keir
- Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
- Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia
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Davidson J, Malhotra Y, Shay R, Arunachalam A, Sink D, Barry JS, Meyers J. Building a NICU quality & safety infrastructure. Semin Perinatol 2024; 48:151902. [PMID: 38692996 DOI: 10.1016/j.semperi.2024.151902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
The American Academy of Pediatrics (AAP) Standards for Levels of Neonatal Care, published in 2023, highlights key components of a Neonatal Patient Safety and Quality Improvement Program (NPSQIP). A comprehensive Neonatal Intensive Care Unit (NICU) quality and safety infrastructure (QSI) is based on four foundational domains: quality improvement, quality assurance, safety culture, and clinical guidelines. This paper serves as an operational guide for NICU clinical leaders and quality champions to navigate these domains and develop their local QSI to include the AAP NPSQIP standards.
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Affiliation(s)
- Jessica Davidson
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States.
| | - Yogangi Malhotra
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Rebecca Shay
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Athis Arunachalam
- Department of Pediatrics, Texas Childrens Hospital & Baylor College of Medicine, Houston, TX, United States
| | - David Sink
- Department of Pediatrics, University of Connecticut School of Medicine, Hartford, CT, United States
| | - James S Barry
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jeffrey Meyers
- Department of Pediatrics, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
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Martin JS, Botta CJ, Bowman S, Giliberti D. Pragmatic Expansion of a Neonatal Antibiotic Stewardship Program in a Community Health Care System. Pediatrics 2024; 153:e2022056356. [PMID: 38093660 DOI: 10.1542/peds.2022-056356] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 01/02/2024] Open
Abstract
BACKGROUND Previously published neonatal antibiotic stewardship efforts have been primarily implemented in single centers. Piedmont Athens Regional began work to decrease antibiotic use in the NICU with spread to the newborn nursery (NBN) and, subsequently, 13 other NICUs and NBNs throughout a health care system over a 4-year period. METHODS This quality improvement initiative was conducted in the context of a multicenter learning collaborative from 2016 to 2019. The primary aim was a 10% reduction in antibiotic days per 1000 patient days (antibiotic utilization rate [AUR]) among newborns in the NICU and NBN at each hospital by December 2018. Change ideas were implemented by using plan-do-study-act cycles. The primary outcome measure was AUR with a balancing measure of antibiotic restarts. RESULTS Piedmont Athens Regional decreased the NICU AUR by 46% and NBN AUR by 83%. Piedmont Healthcare decreased the NICU AUR by 40% and NBN AUR by 74%. Seven of 8 NICUs and 5 of 7 NBNs achieved a >10% reduction in AUR and 8 of 8 intervention hospitals showed a sustained drop in AUR in the NBN, NICU, or both during the 1.5-year postobservation period. Decreases in antibiotic initiation resulted in 335 fewer antibiotic courses in the NICU and 189 fewer infants started on antibiotics in the NBN in 2020 versus 2017. CONCLUSIONS This initiative achieved reductions in AUR across multiple hospitals in the network. The system-wide approach facilitated information technology (IT) and electronic health record modifications. Common drivers of NICU improvement were involvement for at least 2 years, multidisciplinary teams, and the highest baseline AUR. The common driver of nursery improvement was the implementation of a neonatal sepsis risk calculator.
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Affiliation(s)
- Julie S Martin
- Piedmont Athens Regional, Athens, Georgia
- Augusta University/University of Georgia Medical Partnership, Athens, Georgia
| | - Caleb J Botta
- Augusta University/University of Georgia Medical Partnership, Athens, Georgia
| | - Sarah Bowman
- Augusta University/University of Georgia Medical Partnership, Athens, Georgia
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Qureshi N, Kroger J, Zangwill KM, Joshi NS, Payton K, Mendel P. Changes in perceptions of antibiotic stewardship among neonatal intensive care unit providers over the course of a learning collaborative: a prospective, multisite, mixed-methods evaluation. J Perinatol 2024; 44:62-70. [PMID: 38001155 PMCID: PMC10783543 DOI: 10.1038/s41372-023-01823-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/18/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE To assess clinician perceptions towards the value and implementation of antibiotic stewardship (AS) in neonatal intensive care units (NICU). STUDY DESIGN We performed a mixed-methods study of AS perceptions (prescribing appropriateness, importance, activity, capacity) using surveys and interviews in 30 California NICUs before and after a multicenter collaborative (Optimizing Antibiotic Use in California NICUs [OASCN]). RESULTS Pre-OASCN, 24% of respondents felt there was "a lot of" or "some" inappropriate prescribing, often driven by fear of a bad outcome or reluctance to change existing practice. Clinicians reported statistically significant increases in AS importance (71 v 79%), perceived AS activity (67 v 87%), and more openness to change after OASCN (59 v 70%). We identified other concerns that lessen AS effort. CONCLUSION OASCN increased perceived AS activity and openness to change in AS practices among NICU prescribers. Greater attention to subjective concerns should augment AS improvement.
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Affiliation(s)
- Nabeel Qureshi
- RAND Corporation, Santa Monica, CA, USA.
- Pardee RAND Graduate School, Santa Monica, CA, USA.
| | - Jack Kroger
- RAND Corporation, Santa Monica, CA, USA
- Pardee RAND Graduate School, Santa Monica, CA, USA
| | - Kenneth M Zangwill
- Division of Pediatric Infectious Diseases and The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Neha S Joshi
- Stanford University, Division of Pediatric Hospital Medicine, Palo Alto, CA, USA
| | - Kurlen Payton
- Cedars-Sinai Medical Center, Department of Pediatrics, Division of Neonatology, Los Angeles, CA, USA
- California Perinatal Quality Care Collaborative, Stanford, CA, USA
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10
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Senaldi L, Blatt L, Han JY, Gozum G, Venturini SL, Hauft S, Yap V, Acker KP, Osorio SN, Tiwari P. A quality improvement initiative to reduce antibiotic use in transient tachypnea of the newborn. J Perinatol 2024; 44:119-124. [PMID: 38123798 DOI: 10.1038/s41372-023-01850-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Evidence suggests that antibiotics are unnecessary in infants with transient tachypnea of the newborn (TTN) that are low-risk for early-onset sepsis. The aim was to reduce ampicillin and gentamicin days of therapy (DOT) in infants with suspected TTN by 10% within 12 months. STUDY DESIGN We used the Model for Improvement to test interventions from August 2019 to September 2021 to decrease antibiotic utilization in low-risk infants with TTN. Interventions included the creation of an evidence-based clinical pathway, admission huddles, and prescriber audit and feedback. RESULTS We reduced ampicillin and gentamicin use by 26% and 23%, respectively. In 123 infants with suspected TTN, we sequentially decreased starting antibiotics in this group from 71% to 41%, 13% and 0%. There were no cases of missed bacteremia. CONCLUSION Creation of a multidisciplinary antimicrobial stewardship QI team and subsequent interventions were successful in safely reducing antibiotic use in infants with TTN.
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Affiliation(s)
- Liana Senaldi
- Department of Pediatrics, Division of Neonatology, NewYork Presbyterian-Weill Cornell Medicine, New York, NY, USA.
| | - Lauren Blatt
- Department of Pediatrics, Division of Neonatology, NewYork Presbyterian-Weill Cornell Medicine, New York, NY, USA
| | - Jin-Young Han
- Department of Pediatrics, Division of Pediatric Infectious Diseases, NewYork Presbyterian-Weill Cornell Medicine, New York, NY, USA
| | - Giselle Gozum
- Department of Pediatrics, Division of Neonatology, NewYork Presbyterian-Weill Cornell Medicine, New York, NY, USA
| | - Susan L Venturini
- Department of Pediatrics, Division of Neonatology, NewYork Presbyterian-Weill Cornell Medicine, New York, NY, USA
| | - Sherrie Hauft
- Department of Pediatrics, Division of Neonatology, NewYork Presbyterian-Weill Cornell Medicine, New York, NY, USA
| | - Vivien Yap
- Department of Pediatrics, Division of Neonatology, NewYork Presbyterian-Weill Cornell Medicine, New York, NY, USA
| | - Karen P Acker
- Department of Pediatrics, Division of Pediatric Infectious Diseases, NewYork Presbyterian-Weill Cornell Medicine, New York, NY, USA
| | - Snezana Nena Osorio
- Department of Pediatrics, NewYork Presbyterian-Weill Cornell Medicine, New York, NY, USA
| | - Priyanka Tiwari
- Department of Pediatrics, Division of Neonatology, NewYork Presbyterian-Weill Cornell Medicine, New York, NY, USA
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11
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Flannery DD, Zevallos Barboza A, Mukhopadhyay S, Wade KC, Gerber JS, Shu D, Puopolo KM. Antibiotic Use Among Infants Admitted to Neonatal Intensive Care Units. JAMA Pediatr 2023; 177:1354-1356. [PMID: 37812442 PMCID: PMC10562984 DOI: 10.1001/jamapediatrics.2023.3664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/18/2023] [Indexed: 10/10/2023]
Abstract
This cross-sectional study examines antibiotic exposure, days of therapy, types of antibiotics, and changes in use patterns among newborns in neonatal intensive care units (NICUs) across the US from 2009 to 2021.
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Affiliation(s)
- Dustin D. Flannery
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alvaro Zevallos Barboza
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sagori Mukhopadhyay
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kelly C. Wade
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jeffrey S. Gerber
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Di Shu
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Karen M. Puopolo
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Venugopal S, Patil RB, Thukral A, Koganti RA, Kumar Dl V, Sankar MJ, Agarwal R, Verma A, Deorari AK. Feasibility, Sustainability, and Effectiveness of the Implementation of "Facility-Team-Driven" Approach for Improving the Quality of Newborn Care in South India. Indian J Pediatr 2023; 90:974-981. [PMID: 37269503 DOI: 10.1007/s12098-023-04518-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/15/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The primary objective of the study was to assess the feasibility and sustainability of the implementation of the point of care quality improvement (POCQI) methodology for improving the quality of neonatal care at the level 2 special newborn care unit (SNCU). Additional objective was to evaluate the effectiveness of the quality improvement (QI) and preterm baby package training model. METHODS This study was conducted in a level-II SNCU. The study period was divided into baseline; intervention and sustenance phases. The primary outcome i.e., feasibility was defined as completion of training for 80% or more health care professionals (HCPs) through workshops, their attendance in subsequent review meetings and, successful accomplishment of at least two plan-do-study-act (PDSA) cycles in each project. RESULTS Of the total, 1217 neonates were enrolled during the 14 mo study period; 80 neonates in the baseline, 1019 in intervention and 118 in sustenance phases. Feasibility of training was achieved within a month of initiation of intervention phase; 22/24 (92%) nurses and 14/15 (93%) doctors attended the meetings. The outcomes of individual projects suggested an improvement in proportion of neonates being given exclusive breast milk on day 5 (22.8% to 78%); mean difference (95% CI) [55.2 (46.5 to 63.9)]. Neonates on any antibiotics declined, proportion of any enteral feeds on day one and duration of kangaroo mother care (KMC) increased. Proportion of neonates receiving intravenous fluids during phototherapy decreased. CONCLUSIONS The present study demonstrates the feasibility, sustainability, and effectiveness of a facility-team-driven QI approach augmented with capacity building and post-training supportive supervision.
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Affiliation(s)
- S Venugopal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra B Patil
- Department of Pediatrics, Shimoga Medical College, Shivamogga, Karnataka, India
| | - Anu Thukral
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Raja Ashok Koganti
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Vasanth Kumar Dl
- Department of Pediatrics, Shimoga Medical College, Shivamogga, Karnataka, India
| | - M Jeeva Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Agarwal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Verma
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok K Deorari
- Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun, Uttarakhand, India.
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13
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Chitalia RA, Benscoter AL, Chlebowski MM, Hart KJ, Iliopoulos I, Misfeldt AM, Sawyer JE, Alten JA. Implementation of a 24-hour infection diagnosis protocol in the pediatric cardiac intensive care unit (CICU). Infect Control Hosp Epidemiol 2023; 44:1300-1307. [PMID: 36382469 DOI: 10.1017/ice.2022.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To reduce unnecessary antibiotic exposure in a pediatric cardiac intensive care unit (CICU). DESIGN Single-center, quality improvement initiative. Monthly antibiotic utilization rates were compared between 12-month baseline and 18-month intervention periods. SETTING A 25-bed pediatric CICU. PATIENTS Clinically stable patients undergoing infection diagnosis were included. Patients with immunodeficiency, mechanical circulatory support, open sternum, and recent culture-positive infection were excluded. INTERVENTIONS The key drivers for improvement were standardizing the infection diagnosis process, order-set creation, limitation of initial antibiotic prescription to 24 hours, discouraging indiscriminate vancomycin use, and improving bedside communication and situational awareness regarding the infection diagnosis protocol. RESULTS In total, 109 patients received the protocol; antibiotics were discontinued in 24 hours in 72 cases (66%). The most common reasons for continuing antibiotics beyond 24 hours were positive culture (n = 13) and provider preference (n = 13). A statistical process control analysis showed only a trend in monthly mean antibiotic utilization rate in the intervention period compared to the baseline period: 32.6% (SD, 6.1%) antibiotic utilization rate during the intervention period versus 36.6% (SD, 5.4%) during the baseline period (mean difference, 4%; 95% CI, -0.5% to -8.5%; P = .07). However, a special-cause variation represented a 26% reduction in mean monthly vancomycin use during the intervention period. In the patients who had antibiotics discontinued at 24 hours, delayed culture positivity was rare. CONCLUSIONS Implementation of a protocol limiting empiric antibiotic courses to 24 hours in clinically stable, standard-risk, pediatric CICU patients with negative cultures is feasible. This practice appears safe and may reduce harm by decreasing unnecessary antibiotic exposure.
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Affiliation(s)
- Reema A Chitalia
- Department of Pediatrics, The Heart Institute, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Alexis L Benscoter
- Department of Pediatrics, The Heart Institute, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Meghan M Chlebowski
- Department of Pediatrics, The Heart Institute, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kelsey J Hart
- Department of Pediatrics, The Heart Institute, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ilias Iliopoulos
- Department of Pediatrics, The Heart Institute, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrew M Misfeldt
- Department of Pediatrics, The Heart Institute, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jaclyn E Sawyer
- Department of Pediatrics, The Heart Institute, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jeffrey A Alten
- Department of Pediatrics, The Heart Institute, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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14
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Assen KH, Paquette V, Albert AY, Shi G, Srigley JA, Osiovich H, Roberts AD, Ting JY. Effectiveness of a neonatal intensive care unit-specific antimicrobial stewardship program: A ten-year review. Infect Control Hosp Epidemiol 2023; 44:1-7. [PMID: 36734094 DOI: 10.1017/ice.2022.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the change in consumption of specific antibiotics in a neonatal intensive care unit after the implementation of an antimicrobial stewardship program (ASP). DESIGN Retrospective cohort study between January 1, 2010, and December 31,2019. SETTING The neonatal intensive care unit at British Columbia Women's Hospital (Vancouver Canada), a tertiary-care center. PATIENTS Admitted neonates prescribed antibiotics. METHODS We implemented an ASP with an early implementation phase starting in January 2014 (period 2) and a later phase starting in January 2017 (period 3). Patient demographics were collected, including birth weight, gestational age, history of necrotizing enterocolitis (NEC), and surgical operations from existing databases. Interrupted time-series analysis was used, and comparison of antibiotic days of therapy (DOT) averages were conducted across the preimplementation period (period 1), period 2, and period 3 regarding total patients and subgroups. RESULTS We identified 4,512 infants. There was a significant decrease in DOT from 472 (95% confidence interval [CI], 431-517) in period 1 to 405 (95% CI, 367-446) in period 2 to 313 (95% CI, 280-350) in period 3. We detected a significant decrease in the use of ampicillin, aminoglycosides, cloxacillin, and linezolid but not in vancomycin or cefotaxime. Subgroup analyses of infants <1,500 g and those without NEC or surgery showed decreases in the use of cloxacillin, aminoglycosides, and linezolid. CONCLUSIONS The implementation of an ASP was associated with a significant decrease in the overall DOT and use of certain antibiotics. This study presents important targets for ongoing ASP work.
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Affiliation(s)
- Katrina H Assen
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vanessa Paquette
- Department of Pharmacy, Children's and Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Arianne Y Albert
- Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Ginger Shi
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jocelyn A Srigley
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Horacio Osiovich
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ashley D Roberts
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph Y Ting
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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15
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Ren Z, Yang S, Han J, Nie C, Wang C, Wang J, Zheng X, Yang H, Zhang Q, Pei J, Xu F, Yang J. Reduction of antibiotic use and multi-drug resistance bacteria infection in neonates after improvement of antibiotics use strategy in a level 4 neonatal intensive care unit in southern China. Eur J Clin Microbiol Infect Dis 2023; 42:87-98. [PMID: 36409375 DOI: 10.1007/s10096-022-04522-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/04/2022] [Indexed: 11/22/2022]
Abstract
The investigation on antibiotic stewardship in neonatal intensive care unit in China is scarce. This study aimed to analyze the effect of a comprehensive 2-year antibiotic stewardship in a level 4 NICU. During this baseline period from October 1st 2017 to October 1st 2019, continuation of empirical antibiotic therapy for ruled-out sepsis courses was beyond 72 h and for pneumonia was more than 7 days. Meropenem or vancomycin was used even if they were not the only bacterial sensitive antibiotics. The intervention period was from October 2nd 2019 to August 23rd 2021. Three areas for quality improvement were targeted in our center: discontinuation of antibiotic use in ruled-out sepsis within 72 h, treatment duration for culture-negative pneumonia less than 7 days, and vancomycin or meropenem was not used unless the cultured bacteria was only susceptible to them. The total antibiotic consumption decreased from 791.1 to 466.3 days of therapy per 1000 patient days from baseline to intervention period. Antibiotics were stopped within 72 h for 47.48% patients with rule-out sepsis and within 7 days for 75.70% patients with pneumonia compared with 11.56% and 37.69% during the baseline period respectively. The prevalence of multi-drug resistance bacteria decreased from 67.20 to 48.90%. The total use rate of meropenem or vancomycin decreased from 7.6 to 1.8%. Our quality improvement approach on antibiotic strategy significantly reduced antibiotic use and prevalence of multi-drug resistance bacteria in our NICU.
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Affiliation(s)
- Zhuxiao Ren
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China.,Guangdong Neonatal ICU Medical Quality Control Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Shumei Yang
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China.,Guangdong Neonatal ICU Medical Quality Control Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jiangxue Han
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China
| | - Chuan Nie
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China.,Guangdong Neonatal ICU Medical Quality Control Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Cuicui Wang
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jianlan Wang
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xuaner Zheng
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China
| | - Haoming Yang
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China
| | - Qi Zhang
- Department of Clinical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jingjun Pei
- Department of Neonatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fang Xu
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China. .,Guangdong Neonatal ICU Medical Quality Control Center, Guangdong Women and Children Hospital, Guangzhou, China.
| | - Jie Yang
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China. .,Department of Neonatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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16
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Mukhopadhyay S, Briker SM, Flannery DD, Dhudasia MB, Coggins SA, Woodford E, Walsh EM, Li S, Puopolo KM, Kuzniewicz MW. Time to positivity of blood cultures in neonatal late-onset bacteraemia. Arch Dis Child Fetal Neonatal Ed 2022; 107:583-588. [PMID: 35273079 PMCID: PMC9465986 DOI: 10.1136/archdischild-2021-323416] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/21/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To determine the time to positivity (TTP) of blood cultures among infants with late-onset bacteraemia and predictors of TTP >36 hours. DESIGN Retrospective cohort study. SETTING 16 birth centres in two healthcare systems. PATIENTS Infants with positive blood cultures obtained >72 hours after birth. OUTCOME The main outcome was TTP, defined as the time interval from specimen collection to when a neonatal provider was notified of culture growth. TTP analysis was restricted to the first positive culture per infant. Patient-specific and infection-specific factors were analysed for association with TTP >36 hours. RESULTS Of 10 235 blood cultures obtained from 3808 infants, 1082 (10.6%) were positive. Restricting to bacterial pathogens and the first positive culture, the median TTP (25th-75th percentile) for 428 cultures was 23.5 hours (18.4-29.9); 364 (85.0%) resulted in 36 hours. Excluding coagulase-negative staphylococci (CoNS), 275 of 294 (93.5%) cultures were flagged positive by 36 hours. In a multivariable model, CoNS isolation and antibiotic pretreatment were significantly associated with increased odds of TTP >36 hours. Projecting a 36-hour empiric duration at one site and assuming that all negative evaluations were associated with an empiric course of antibiotics, we estimated that 1164 doses of antibiotics would be avoided in 629 infants over 10 years, while delaying a subsequent antibiotic dose in 13 infants with bacteraemia. CONCLUSIONS Empiric antibiotic administration in late-onset infection evaluations (not targeting CoNS) can be stopped at 36 hours. Longer durations (48 hours) should be considered when there is pretreatment or antibiotic therapy is directed at CoNS.
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Affiliation(s)
- Sagori Mukhopadhyay
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sara M Briker
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Dustin D Flannery
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Miren B Dhudasia
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sarah A Coggins
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Emily Woodford
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Eileen M Walsh
- Division of Research, Kaiser Permanente Northern California, San Francisco, California, USA
| | - Sherian Li
- Division of Research, Kaiser Permanente Northern California, San Francisco, California, USA
| | - Karen M Puopolo
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael W Kuzniewicz
- Division of Research, Kaiser Permanente Northern California, San Francisco, California, USA
- Department of Pediatrics, Kaiser Permanente Northern California, San Francisco, California, USA
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17
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赵 娟, 韩 树, 余 章, 潘 兆, 周 勤, 姜 善, 万 俊, 张 琳, 王 淮, 孟 孟, 徐 艳, 陈 筱, 薛 梅, 杨 丽, 吴 明, 顾 瓅, 卢 红, 乔 瑜, 吴 新, 谷 传, 侯 玮, 高 艳, 仰 守, 张 纪, 刘 松. [Antibiotic use in very low birth weight/extremely low birth weight infants in 15 hospitals in Jiangsu Province of China: a multicenter survey]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:988-993. [PMID: 36111716 PMCID: PMC9495234 DOI: 10.7499/j.issn.1008-8830.2204165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To investigate the current status of antibiotic use in very low birth weight/extremely low birth weight infants in Jiangsu Province of China, and to provide a clinical basis for the quality and improvement of antibiotic management in the neonatal intensive care unit (NICU). METHODS A retrospective analysis was performed on the data on general conditions and antibiotic use in the very low birth weight/extremely low birth weight infants who were admitted to 15 hospitals of Jiangsu Province from January 1, 2019 to December 31, 2020. A questionnaire containing 10 measures to reduce antibiotic use was designed to investigate the implementation of these intervention measures. RESULTS A total of 1 920 very low birth weight/extremely low birth weight infants were enrolled, among whom 1 846 (96.15%) were treated with antibiotic, and the median antibiotic use rate (AUR) was 50/100 patient-days. The AUR ranged from 24/100 to 100/100 patient-days in the 15 hospitals. After adjustment for the confounding factors including gestational age, birth weight, and neonatal critical score, the Poisson regression analysis showed that there was a significant difference in the adjusted AUR (aAUR) among the hospitals (P<0.01). The investigation results showed that among the 10 measures to reduce antibiotic use, 8 measures were implemented in less than 50% of these hospitals, and the number of intervention measures implemented was negatively correlated with aAUR (rs=-0.564, P=0.029). CONCLUSIONS There is a high AUR among the very low birth weight/extremely low birth weight infants in the 15 hospitals of Jiangsu Province, with a significant difference among hospitals. The hospitals implementing a relatively few measures to reduce antibiotic use tend to have a high AUR. It is expected to reduce AUR in very low birth weight/extremely low birth weight infants by promoting the quality improvement of antibiotic use management in the NICU.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - 孟 孟
- 徐州医科大学附属医院 新生儿科,江苏徐州221002
| | - 艳 徐
- 徐州医科大学附属医院 新生儿科,江苏徐州221002
| | - 筱青 陈
- 南京医科大学第一附属医院新生儿科,江苏南京210004
| | | | | | | | | | | | | | | | | | | | - 艳 高
- 连云港市妇幼保健院 新生儿科,江苏连云港222000
| | - 守红 仰
- 连云港市妇幼保健院 新生儿科,江苏连云港222000
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18
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褚 梅, 王 铭, 林 锦, 杨 舸, 丁 颖, 廖 正, 曹 传, 岳 少. [Effect of improvement in antibiotic use strategy on the short-term clinical outcome of preterm infants with a gestational age of <35 weeks]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:521-529. [PMID: 35644192 PMCID: PMC9154368 DOI: 10.7499/j.issn.1008-8830.2201016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/08/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To study the effect of improvement in antibiotic use strategy on the short-term clinical outcome of preterm infants with a gestational age of <35 weeks. METHODS The medical data were retrospectively collected from 865 preterm infants with a gestational age of <35 weeks who were admitted to the Neonatal Intensive Care Unit of Xiangya Hospital of Central South University from January 1, 2014 to December 31, 2016. The improved antibiotic use strategy was implemented since January 1, 2015. According to the time of implementation, the infants were divided into three groups: pre-adjustment (January 1, 2014 to December 31, 2014; n=303), post-adjustment Ⅰ (January 1, 2015 to December 31, 2015; n=293), and post-adjustment Ⅱ (January 1, 2016 to December 31, 2016; n=269). The medical data of the three groups were compared. RESULTS There were no significant differences among the three groups in gestational age, proportion of small-for-gestational-age infants, sex, and method of birth (P>0.05). Compared with the pre-adjustment group, the post-adjustment I and post-adjustment Ⅱ groups had a significant reduction in the rate of use of antibiotics and the duration of antibiotic use in the early postnatal period and during hospitalization (P<0.05), with a significant increase in the proportion of infants with a duration of antibiotic use of ≤3 days or 4-7 days and a significant reduction in the proportion of infants with a duration of antibiotic use of >7 days in the early postnatal period (P<0.05). Compared with the post-adjustment Ⅰ group, the post-adjustment Ⅱ group had a significant reduction in the duration of antibiotic use in the early postnatal period and during hospitalization (P<0.05), with a significant increase in the proportion of infants with a duration of antibiotic use of ≤3 days and a significant reduction in the proportion of infants with a duration of antibiotic use of 4-7 days or >7 days (P<0.05). Compared with the pre-adjustment group, the post-adjustment I and post-adjustment Ⅱ groups had significantly shorter duration of parenteral nutrition and length of hospital stay (P<0.05). There were gradual reductions in the incidence rates of grade ≥Ⅲ intraventricular hemorrhage (IVH) and late-onset sepsis (LOS) after the adjustment of antibiotic use strategy. The multivariate logistic regression analysis showed that the adjustment of antibiotic use strategy had no effect on short-term adverse clinical outcomes, and antibiotic use for >7 days significantly increased the risk of adverse clinical outcomes (P<0.05). CONCLUSIONS It is feasible to reduce unnecessary antibiotic use by the improvement in antibiotic use strategy in preterm infants with a gestational age of <35 weeks, which can also shorten the duration of parenteral nutrition and the length of hospital stay and reduce the incidence rates of grade ≥Ⅲ IVH and LOS.
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19
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Hemodynamic Quality Improvement Bundle to Reduce the Use of Inotropes in Extreme Preterm Neonates. Paediatr Drugs 2022; 24:259-267. [PMID: 35469390 DOI: 10.1007/s40272-022-00502-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND We evaluated the effect of the quality improvement (QI) bundle on the rate of inotrope use and associated morbidities. METHODS We included inborn preterm neonates born at < 29 weeks admitted to level III NICU. We implemented a QI bundle focusing on the first 72 h from birth which included delayed cord clamping, avoidance of routine echocardiography, the addition of clinical criteria to the definition of hypotension, factoring iatrogenic causes of hypotension, and standardization of respiratory management. The rate of inotropes use was compared before and after implementing the care bundle. Incidence of cystic periventricular leukomalacia (cPVL) was used as a balancing measure. RESULTS QI bundle implementation was associated with significant reduction in overall use of inotropes (24 vs 7%, p < 0.001), dopamine (18 vs 5%, p < 0.001), and dobutamine (17 vs 4%, p < 0.001). Rate of acute brain injury decreased significantly: acute brain injury of any grade (34 vs 20%, p < 0.001) and severe brain injury (15 vs 6%, p < 0.001). There was no difference in the incidence of cPVL (0.8 vs 1.4%, p = 0.66). Associations remained significant after adjusting for confounding factors. CONCLUSIONS A quality improvement bundled approach resulted in a reduction in inotropes use and associated brain morbidities in premature babies.
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20
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Kahn DJ, Perkins BS, Barrette CE, Godin R. Reducing Antibiotic Use in a Level III and Two Level II Neonatal Intensive Care Units Targeting Prescribing Practices for Both Early and Late-onset Sepsis: A Quality Improvement Project. Pediatr Qual Saf 2022; 7:e555. [PMID: 35720871 PMCID: PMC9197376 DOI: 10.1097/pq9.0000000000000555] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/17/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Variation in antibiotic (ATB) use exists between neonatal intensive care units (NICUs) without demonstrated benefit to outcomes tested. Studies show that early-onset sepsis occurs in up to 2% of NICU patients, yet antibiotics (ABX) were started in over 50% of neonates admitted to our NICUs. An internal audit identified variations in prescribing practices and excessive use of ABX. As a result, we introduced ATB stewardship to our NICUs in 2015 to reduce unnecessary usage of these medications. Methods We used standard quality improvement methodology utilizing multiple iterative plan-do-study-act cycles during a 6-year project to test various interventions aimed at using ABX wisely. Specifically, our goals were to reduce ABX on admission (AA), percent of patients who continued on ABX beyond 72 hours of life (AC), and ATB utilization rate in our 3 NICUs by 28% for each metric. Interventions implemented included the development of an ATB stewardship program consisting of a multidisciplinary team that met regularly, creation of tools and guidelines for evaluations of sepsis and ATB use, universal use of the neonatal early-onset sepsis calculator for all newborns 34 weeks and older gestational age, education regarding noninitiation of ABX for maternal indications in clinically well newborns, and discontinuation within 48 hours for asymptomatic newborns with negative blood cultures. Results AA, AC, and ATB utilization rate decreased by 34.1%, 45.3%, and 34.9%, respectively, in our 3 NICUs. Conclusions By introducing ATB stewardship in our NICUs, we exceeded our predetermined goal of significantly reducing ATB usage.
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Affiliation(s)
- Doron J. Kahn
- From the Division of Neonatology, Joe DiMaggio Children’s Hospital, Hollywood, FL
- Mednax Services, Inc., Sunrise, FL
| | - Beckett S. Perkins
- From the Division of Neonatology, Joe DiMaggio Children’s Hospital, Hollywood, FL
- Mednax Services, Inc., Sunrise, FL
| | - Claire E. Barrette
- From the Division of Neonatology, Joe DiMaggio Children’s Hospital, Hollywood, FL
- Mednax Services, Inc., Sunrise, FL
| | - Robert Godin
- Department of Pharmacy, Joe DiMaggio Children’s Hospital, Hollywood, FL
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Yu Y, Dong Q, Li S, Qi H, Tan X, Ouyang H, Hu J, Li W, Wang T, Yang Y, Gong X, He X, Chen P. Etiology and clinical characteristics of neonatal sepsis in different medical setting models: A retrospective multi-center study. Front Pediatr 2022; 10:1004750. [PMID: 36275054 PMCID: PMC9581286 DOI: 10.3389/fped.2022.1004750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE General hospitals admit lower gestational age neonates than maternal and child health care centers, therefore associated with a higher morbidity and mortality. This study aimed to assess the etiology and clinical characteristics of neonatal sepsis in different medical setting models. METHODS Neonates admitted to 5 tertiary medical centers, including one national general hospital, two maternal and child health care hospitals and two regional general hospitals, in central-south China with culture-proven sepsis between January 2010 and December 2019 were included in the study. We compared maternal and neonatal characteristics, pathogen distribution, treatment and neonatal outcomes among 3 different medical setting models in this retrospective cohort. RESULTS We identified 757 episodes of culture-proven sepsis in 757 neonates. The predominant pathogens were coagulase-negative staphylococci, Klebsiella pneumoniae, Escherichia coli and Group B streptococci. A total of 683 neonates with detailed information were involved in further comparison; 54.6% were from the national general hospital, 35.9% were from the maternal and child health care hospital, and 9.5% were from the regional general hospital. Neonates in national and regional general hospitals had significantly lower gestational age and birthweight (P < 0.001). Patterns of pathogen distribution were different among these medical setting models. Early-onset sepsis was more common in maternal and child health care hospitals (61.4% vs. 42.1% vs. 46.7%, P < 0.001), while hospital-acquired late-onset sepsis was more common in national and regional general hospitals (32.7% vs. 33.3% vs. 11.4%, P < 0.001). The proportion of complications or comorbidities of neonates in maternal and child health care hospitals were significantly lower than neonates in national and regional general hospitals (P < 0.001). The case fatality rate was significantly higher in regional general hospitals (10.8% vs. 3.2% vs. 0.8%, P = 0.001). CONCLUSION We report distinct patterns of clinical characteristics, pathogens and outcomes in patient subgroups with neonatal sepsis from national general hospital, maternal and child health care hospital and regional general hospital. It might have some implications for improvement of prevention, management and empirical antibiotic use in neonatal sepsis in different setting models, especially in resource-limited settings from middle and low-income countries.
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Affiliation(s)
- Yuanqiang Yu
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Laboratory of Neonatal Disease, Institute of Pediatrics, Central South University, Changsha, China
| | - Qingyi Dong
- Department of Neonatology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Suping Li
- Department of Neonatology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Huaxue Qi
- Department of Neonatology, Changsha Hospital for Maternal / Child Health Care, Changsha, China
| | - Xin Tan
- Department of Pediatrics, The First Hospital of Changsha, Changsha, China
| | - Hong Ouyang
- Department of Neonatology, Xiangtan Central Hospital, Xiangtan, China
| | - Jintao Hu
- Department of Neonatology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wen Li
- Department of Neonatology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Tao Wang
- Department of Neonatology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yonghui Yang
- Department of Neonatology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoyun Gong
- Department of Neonatology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaori He
- Department of Neonatology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Pingyang Chen
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Laboratory of Neonatal Disease, Institute of Pediatrics, Central South University, Changsha, China
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22
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Singhal A, Shaw S, Mahesh M. Antimicrobial resistance an alarming global concern: Antimicrobial stewardship is the key. JOURNAL OF MARINE MEDICAL SOCIETY 2022. [DOI: 10.4103/jmms.jmms_167_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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23
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Managing antibiotics wisely in a neonatal intensive care unit in a low resource setting. J Perinatol 2022; 42:965-970. [PMID: 35459905 PMCID: PMC9023725 DOI: 10.1038/s41372-022-01388-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 03/17/2022] [Accepted: 03/31/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Unnecessary early antibiotic exposure is deleterious, it may induce the selection of multi-drug-resistant organisms. The objective of this project was to decrease antibiotic exposure of newborns admitted to the neonatal intensive care unit at Hospital Cayetano Heredia, a level 3 unit in Lima, Peru. METHODS Quality improvement project in which we implemented an antibiotic stewardship program for early onset sepsis in the neonatal intensive care unit. Primary outcome measure was antibiotic usage rate, total number of days infants were exposed to antibacterial agents divided by 1000 patient-days. RESULTS Antibiotic usage rate declined from 291/1000 patient-days to 82/1000 patient-days during the last months of 2020, representing a total decrease of 65.1%. CONCLUSIONS Antibiotic stewardship for early-onset sepsis implemented in a perinatal center like ours is effective, appears to be safe and results in a sustained and significant decrease in the use of antibiotics for early-onset sepsis.
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Morales-Betancourt C, De la Cruz-Bértolo J, Muñoz-Amat B, Bergón-Sendín E, Pallás-Alonso C. Reducing Early Antibiotic Use: A Quality Improvement Initiative in a Level III Neonatal Intensive Care Unit. Front Pediatr 2022; 10:913175. [PMID: 35712636 PMCID: PMC9192948 DOI: 10.3389/fped.2022.913175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Antibiotic burden is a critical issue in neonatal intensive care units (NICU) and antibiotic use is considered a quality indicator of neonatal care. Our aim was to optimize antibiotic use through a quality improvement (QI) initiative that included revision of departmental protocols and implementation of a surveillance system based on process indicators. METHODS This is descriptive study of a cohort of all very low birth weight (VLBW) infants admitted to the NICU from 2014 to 2019. A series of QI interventions were made during the study period and included departmental protocols and the implementation of a surveillance system based on process indicators. The primary outcome was the percentage of VLBW infants who had received early antibiotics (ampicillin, gentamicin, or cefotaxime on the day of birth or day 1 or 2 after birth), antibiotics for longer than 3 days (despite negative blood culture), or no antibiotics. RESULTS During the study period, a significant relative reduction was seen in the proportion of VLBW infants administered early antibiotics (46%; p < 0.01) and in infants provided antibiotics for longer than 3 days (90%; p < 0.01). Additionally, the percentage of VLBW with "no antibiotics" during their NICU stay increased fivefold (6 to 30%; p < 0.001). CONCLUSIONS In our NICU, the implementation of a QI initiative that is based on affordable methods to track process indicators and evaluate the results led into a significant reduction in antibiotic exposure in VLBW infants. This approach is easy to implement in other NICUs as well.
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Affiliation(s)
| | | | - Bárbara Muñoz-Amat
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
| | - Elena Bergón-Sendín
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain.,Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Pallás-Alonso
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain.,Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, Madrid, Spain
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25
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Lee SY, An SH. Impact of pharmacist intervention in antibiotic stewardship programmes for critically ill neonates: A systematic review and meta-analysis. J Clin Pharm Ther 2021; 47:430-444. [PMID: 34716722 DOI: 10.1111/jcpt.13553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/11/2021] [Accepted: 10/17/2021] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Antibiotic stewardship programmes (ASPs) are introduced to ensure effective antibiotic use. Pharmacists can be involved in ASPs to facilitate the appropriate antibiotic use. Prolonged use of antibiotics causes adverse events in critically ill neonates. Hence, this systematic review and meta-analysis was aimed at investigating pharmacists' functions in ASPs in critically ill neonates and the effect of ASP implementation on antibiotic use. METHODS A comprehensive search of PubMed/Medline, Embase, and Cochrane Library databases until January 2021 was conducted and studies that reported the functions of pharmacists in ASPs for critically ill neonates and the results of ASP implementation were included in this review. All processes were performed by two reviewers independently, and any discordance between the two was resolved by discussion. RESULTS AND DISCUSSION In all, 19 studies were included in this review. Pharmacists were found to have various functions in ASPs, such as participating in the development of antibiotic use guidelines, auditing antibiotic prescriptions, participating in multidisciplinary ward rounds, educating other ASP team members, checking blood culture or laboratory data, and monitoring antibiotic use. A meta-analysis revealed that ASP implementation in critically ill neonates was significantly associated with a 23% reduction in the overall antibiotic use rate (ratio of means: 0.77, 95% confidence interval: 0.69-0.87, p < 0.001). Moreover, the overall duration of antibiotic therapy significantly reduced by 15% with ASP implementation (ratio of means: 0.85, 95% confidence interval: 0.78-0.91, p < 0.001). WHAT IS NEW AND CONCLUSION The implementation of ASPs involving pharmacists, especially in critically ill neonates, was associated with the reduced use and duration of antibiotic treatment. Thus, pharmacists played a key role in ASPs in critically ill neonates.
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Affiliation(s)
- So Yeon Lee
- College of Pharmacy, Wonkwang University, Iksan, Korea
| | - Sook Hee An
- College of Pharmacy, Wonkwang University, Iksan, Korea
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