191 - Antibiotic Stewardship in the Neonatal Intensive Care Unit: An Experience at Kaiser Permanente – Panorama City

Poster Number: 191
Publication Number: 191.439

Maria Fe B. Villosis, Kaiser Permanente Bernard J. Tyson School of Medicine, Panorama City, CA, United States; Ma. Teresa Ambat, Kaiser Permanente Bernard J. Tyson School of Medicine, Valley Glen, CA, United States; Karine Barseghyan, Kaiser Permanente Bernard J. Tyson School of Medicine, Panorama City, CA, United States; Kambiz Kevin. Rezaie, Kaiser Panorama City, Panorama City, CA, United States; Harry Chang, Kaiser Permanente Pediatric Care Center, Panorama City, CA, United States; alexandra Diamond, Kaiser Permanente - panorama City, Panorama city, CA, United States; Aram Shamilian, Kaiser Permanente Pediatric Care Center, 6657 Denny Avenue, CA, United States; Ahmed Saleem, Kaiser Permanente Pediatric Care Center, Panorama City, CA, United States; Christopher J. Booth, Kaiser Permanente Pediatric Care Center, Panorama City, CA, United States

Background: Antibiotic over-use continues to be a major concern across many neonatal intensive care units (NICU) resulting in increased risk of neonatal morbidities. 
Implementation of NICU-specific Antibiotic Stewardship Program (ASPs) through quality improvement (QI) projects has been demonstrated consistently to improve clinical outcomes and minimize harms by improving antibiotic prescribing practices.

Objective: 1. To evaluate the overall antimicrobial utilization rate (AUR) and prescription practices at Kaiser Permanente-Panorama City (KP-PC) NICU after implementation of ASP over a 12-month period.
2. To determine the impact of ASP on 2 groups of infants: a) premature infants < 35 weeks gestation and b) late preterm and term infants > 35 weeks gestation.

Design/Methods: A QI project, as part of a state-wide collaborative aimed at reducing antibiotic utilization by 20% in all participating NICUs. Evidence based-interventions, developed by a multi-disciplinary team, were implemented and evaluated using the Plan Do Study Act (PDSA) methodology. KP-PC NICU, is a 24-bed level III non-surgical NICU. All neonates prescribed antimicrobials from January 2019-December 2021 were eligible for inclusion. Pre-intervention period (January 2019-December 2020) and Intervention period (January-December 2021). 
INTERVENTIONS: 1. Implementation of treatment algorithms for early onset sepsis for 2 gestational age categories: < 35 weeks and > 35 weeks; 2. Initial antibiotic order with hard stop at 36 hours; and 3. Antibiotic time out conducted daily consisting of review of indications, clinical course, laboratory results and plan for length of therapy.

Results: The implementation of ASP resulted in significant decrease in antibiotic usage in our unit that exceeded the collaborative's minimum goal of 20%. The overall AUR decreased by 46% from a baseline of 7% in 2019 and 9.9% in 2020 to 4.6% in 2021. Marked reduction in AUR was also observed when evaluated separately by age categories: 59% decrease from baseline of 6.7% (2019-2020) to 2.6% in 2021 in premature infants < 35 weeks and 45% decrease from baseline of 15.9% (2019-2020) to 8.6% in late preterm and term infants > 35 weeks. The neonatal antibiotic exposure (NAE) decreased by 39% from baseline of 5.6% (2019-2020) to 3.4% in 2021.

Conclusion(s): Multiple interventions incorporated in NICU-specific ASP in our unit resulted in reduction of AUR overall and in 2 groups of infants subdivided by age categories. This was possible through our participation in state-wide collaborative, multi-disciplinary team-based approach, adherence to treatment algorithms and antibiotic utilization review.