733 - Reducing Duration of Empiric Antibiotic Therapy for Neonatal Early Onset Sepsis Evaluations in the NICU

Poster Number: 733
Publication Number: 733.342

Daniela Di Caro, Cohen Children's Medical Center, New Hyde Park, NY, United States; Yan Nuzbrokh, Cohen Children's Medical Center, Long Island City, NY, United States; Alby Jacob, Cohen Children's Medical Center, New Hyde Park, NY, United States; Denise E. Iacono, Cohen Children's Medical Center, New Hyde Park, NY, United States; Alpna Aggarwal, Cohen Children's Medical Center, Manhasset, NY, United States

Background: Standard of care for suspected early onset sepsis (EOS) in neonates is to provide empiric antibiotics for 36-48 hours pending a negative blood culture result. Advancements in laboratory techniques have shown time to positivity (TTP) of EOS pathogens to be ≤ 36 hours in 94% of cases. Baseline data in our Neonatal ICU showed that 100% of positive blood cultures drawn for suspected EOS in infants of all gestational ages were resulted in ≤ 24 hours. This prompted the development of a new unit specific guideline recommending discontinuation of empiric antibiotics at 24 hours in the setting of a negative blood culture to reduce unnecessary antibiotic exposure.

Objective: The aim of this quality initiative was to increase guideline adherence from 0% in May 2021 to 75% by June 30, 2022.  

Design/Methods: We established a multidisciplinary team of physicians, advanced clinical providers, nurses, pharmacists, and the microbiology lab to identify early barriers to guideline adherence after implementation. Quality improvement cycles included (1) educating faculty on the blood culture reporting process, (2) reminding the medical team to discuss time to review culture results and intent to discontinue antibiotics on rounds and during hand-offs, (3) encouraging providers to modify orders to stop antibiotics after administration of 4 doses of Ampicillin (time 0, 8, 16, and 24h based on an 8-hour schedule) and 1 dose of Gentamicin (time 0h based on a 36–48-hour schedule), and (4) ensuring appropriate documentation on decision to continue antibiotics despite a negative blood culture result. The percentage of workups where orders were modified to discontinue antibiotics after the 4th dose of Ampicillin was used to study the impact on guideline adherence.

Results: EOS cases where antibiotic orders were adjusted per our recommended dosing schedule were tracked monthly from May 2021-June 2022. The percentage of neonates with negative blood cultures reported at 24 hours who had an order modified to stop antibiotics after the appropriate number of doses rose from 0% to 65%. Adherence to the guideline concomitantly increased from 0% to 81% suggesting that other PDSA cycles may have also contributed to increased compliance. All positive cultures were identified by 24 hours.

Conclusion(s): Standardization of empiric antibiotic use for EOS evaluations in our NICU coupled with improvement cycles targeting education and physician order entry behaviors, allowed us to reduce unnecessary and potentially harmful antibiotic exposures without compromising the safety of our neonates.