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Implementation of an Antimicrobial Stewardship Program in a Neonatal Intensive Care Unit

Published online by Cambridge University Press:  26 July 2017

Nneka I. Nzegwu ,
Michelle R. Rychalsky ,
Loren A. Nallu ,
Xuemei Song ,
Yanhong Deng ,
Amber M. Natusch ,
Robert S. Baltimore ,
George R. Paci  and
Matthew J. Bizzarro
Nneka I. Nzegwu
Affiliation:
Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
Michelle R. Rychalsky
Affiliation:
Pharmacy Services, Yale-New Haven Hospital, New Haven, Connecticut
Loren A. Nallu
Affiliation:
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
Xuemei Song
Affiliation:
Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut
Yanhong Deng
Affiliation:
Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut
Amber M. Natusch
Affiliation:
Neonatal Intensive Care Unit, Yale-New Haven Children’s Hospital, New Haven, Connecticut
Robert S. Baltimore
Affiliation:
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut Hospital Epidemiology and Infection Control, Yale-New Haven Hospital, New Haven, Connecticut
George R. Paci
Affiliation:
Hospital Epidemiology and Infection Control, Yale-New Haven Hospital, New Haven, Connecticut
Matthew J. Bizzarro*
Affiliation:
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
*
Address correspondence to Matthew J. Bizzarro, MD, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, PO Box 208064, New Haven, CT 06520-8064 ([email protected]).
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Abstract

OBJECTIVE

To evaluate antimicrobial utilization and prescription practices in a neonatal intensive care unit (NICU) after implementation of an antimicrobial stewardship program (ASP).

DESIGN

Quasi-experimental, interrupted time-series study.

SETTING

A 54-bed, level IV NICU in a regional academic and tertiary referral center.

PATIENTS AND PARTICIPANTS

All neonates prescribed antimicrobials from January 1, 2011, to June 30, 2016, were eligible for inclusion.

INTERVENTION

Implementation of a NICU-specific ASP beginning July 2012.

METHODS

We convened a multidisciplinary team and developed guidelines for common infections, with a focus on prescriber audit and feedback. We conducted an interrupted time-series analysis to evaluate the effects of our ASP. Our primary outcome measure was days of antibiotic therapy (DOT) per 1,000 patient days for all and for select antimicrobials. Secondary outcomes included provider-specific antimicrobial prescription events for suspected late-onset sepsis (blood or cerebrospinal fluid infection at >72 hours of life) and guideline compliance.

RESULTS

Antibiotic utilization decreased by 14.7 DOT per 1,000 patient days during the stewardship period, although this decrease was not statistically significant (P=.669). Use of ampicillin, the most commonly antimicrobial prescribed in our NICU, decreased significantly, declining by 22.5 DOT per 1,000 patient days (P=.037). Late-onset sepsis evaluation and prescription events per 100 NICU days of clinical service decreased significantly (P<.0001), with an average reduction of 2.65 evaluations per year per provider. Clinical guidelines were adhered to 98.75% of the time.

CONCLUSIONS

Implementation of a NICU-specific antimicrobial stewardship program is feasible and can improve antibiotic prescribing practices.

Infect Control Hosp Epidemiol 2017;38:1137–1143

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 10 , October 2017 , pp. 1137 - 1143
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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