Antibiotic Stewardship Guidelines Reduce Adverse Events in NICU Patients

Daily reports of antibiotic prescriptions lessened unnecessary treatment among infants in the neonatal intensive care unit.

The Yale University School of Medicine neonatal intensive care unit (NICU) was able to diminish the number of late-onset sepsis cases in pre-term infants through the implementation of new guidelines, according to a study published by Infection Control & Hospital Epidemiology.

The novel guidelines were crafted to reduce the overuse of antibiotics and lessened variability in treating infections in this vulnerable population. These practices were observed to improve adherence to best practices, according to the study.

“It can be difficult to distinguish infections from other disease symptoms in pre-term infants. Timely interventions for a true infection are critical, but unnecessary exposures to

antibiotics can result in antimicrobial resistance, increased risk for serious health conditions, or even death,” said study author Nneka Nzegwu, DO. “We are encouraged that antimicrobial stewardship in the NICU is gaining focus and attention. Our hope is that our experience assists others on a similar journey.”

The multidisciplinary team of researchers created an antibiotic stewardship program that featured clinical guidelines published on the hospital’s intranet in an effort to reduce provider variability in prescriptions. This practice also aimed to provide education and establish principles of stewardship, revisit guidelines, and present outcomes measures, according to the study.

Each day, a report was developed using antibiotic prescription data from electronic health records. The report was reviewed by stewardship members to provide oversight and feedback, according to the authors.

The investigators found that the intervention reduced healthcare-associated infections. The stewardship guidelines were observed to reduce an average of 2.65 late-onset sepsis evaluations per year per providers.

Prior to the intervention in 2011, the NICU had an average of 21.2 evaluations per 100 days, which decreased to 8.4 by 2016, according to the study.

The authors also found that physicians were more likely to adhere to clinical guidelines. Under the program, physicians followed guidelines for 98.7% of antibiotic treatments. Importantly, no infants with infections developed recurrent infection within 7 days of discontinuing treatment, according to the study.

These results suggest that implementing a similar program in additional hospitals would successfully drive down antibiotic resistance and improve treatment for NICU patients, according to the authors.

“So few antimicrobial stewardship programs provide NICU-specific guidelines to cut down on unnecessary prescription practices,” said study author Matthew Bizzarro, MD. “Our use of an electronic medical record-generated daily report, with additional information on the rationale behind each prescription event was somewhat novel and incredibly useful in providing timely feedback and review of prescriber practices.”