Standardizing Antibiotic Prescribing by Applying the Principles of Antibiotic Stewardship in a Level IV NICU

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Antibiotics are the most used medications in neonatal intensive care units (NICUs) and are indicated for the treatment of early and late-onset sepsis which is a cause of morbidity and mortality for neonates. Variability in antibiotic prescribing practices can increase the risk of antibiotic resistance and disrupt the intestinal microbiome. Antibiotic stewardship principles aim to reduce the harm associated with antibiotic misuse and have been shown to reduce prescribing variability and improve patient outcomes. The present study is a quality improvement project aimed at standardizing antibiotic prescribing for patients with neonatal sepsis in the Level IV NICU at Nemours/Alfred I. duPont Hospital for Children in 2020. The Institute for Healthcare Improvement’s Model for Improvement plan-do-study-act cycles were used to introduce small tests of change following the implementation of standardized treatment guidelines and an EHR-based order set for antibiotics for sepsis. These antibiotic stewardship interventions resulted in an improvement in antibiotic prescribing practices in the NICU with no increase in infection or adverse drug events. Compliance with the use of standard antibiotic choices increased monthly throughout the study period. Antibiotic-related pharmacy interventions including drug order selection, duplication, discontinuation, and clarification all declined during the study. The greatest impact of the interventions was found with an increase in the use of narrow-spectrum antibiotic combinations for the treatment of late-onset sepsis. Because 45% of the patients treated for suspected sepsis in 2020 were treated for late-onset sepsis, this change is expected to improve care and reduce the harm associated with the misuse of antibiotics. Future studies will focus on standardizing antibiotic prescribing for other neonatal indications such as necrotizing enterocolitis.



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