667 - Little by little, one travels far: 7 years of antibiotic stewardship in a single-center NICU

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 667
Publication Number: 667.241

Dalyn B. Guinn, The University of Texas Health Science Center at San Antonio Joe R. and Teresa Lozano Long School of Medicine, SAN ANTONIO, TX, United States; Amy C. Hong, The University of Texas Health Science Center at San Antonio Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, United States; Joseph B. Cantey, The University of Texas Health Science Center at San Antonio Joe R. and Teresa Lozano Long School of Medicine, SAN ANTONIO, TX, United States

Presenting Author(s)

Dalyn B. Guinn, DO (she/her/hers)

Resident, PGY-2
The University of Texas Health Science Center at San Antonio Joe R. and Teresa Lozano Long School of Medicine
SAN ANTONIO, Texas, United States

Background: Antibiotics are used frequently in the neonatal intensive care unit (NICU). Prolonged or unnecessary antibiotic exposure has been associated with short- and long-term adverse infant outcomes. Stewardship interventions can safely reduce volume or spectrum of antibiotic use.

Objective: To describe a longitudinal NICU stewardship experience aimed at reducing volume and spectrum of antibiotic consumption in a level IV NICU during a 7-year period.

Design/Methods: Retrospective analysis of a prospectively collected cohort of all infants admitted to a single level IV NICU during a 7-year period (9/15 to 12/21). The NICU resides in a large, academically affiliated county hospital in South Texas and cares for inborn and outborn infants. Demographic and clinical data were collected for all infants. Indication, selection, and duration of all antibiotic doses were collected. Following a baseline period (September 1, 2015 to June 1, 2017), a series of interventions including 1) onboarding a neonatal infectious disease specialist, 2) instituting an electronic medical record antibiotic “hard stop” at 36 hours, 3) using oxacillin and gentamicin as default empiric therapy for late-onset sepsis, 4) emphasizing the performance of lumbar puncture for all cases of suspected late-onset sepsis, 5) developing a dedicated vascular access team, 6) partnering with surgical subspecialties to minimize empiric or prophylactic antibiotics for selected conditions (eg, abdominal wall defects, vesicoureteral reflux), and 7) providing ongoing education for physician and nursing staff were implemented. Antibiotic use was quantified using days of therapy (DOT) per 1000 patient-days (PD) throughout the study period. The antibiotic spectrum index (ASI) proposed by Gerber et al. was used to determine spectrum. Selected safety outcomes included length of stay, late-onset sepsis, necrotizing enterocolitis (NEC), and mortality.

Results: 4,111 infants were admitted during the study period. During the baseline period, antibiotic use was 281.3 DOT per 1000 PD, with a median daily ASI of 9 (IQR 5-12). By the last 6 months of the study period, DOT had declined to 176.1 DOT per 1000 PD (38% reduction) and median daily ASI had declined to 5 (IQR 3-7). Median length of stay, sepsis, NEC, and mortality were unchanged throughout the study period.

Conclusion(s): Ongoing, multidisciplinary interventions can be safe and effective drivers of antibiotic stewardship in the NICU setting. Duration and spectrum can be reduced without adversely affecting patient safety.