547 - Antibiotic Therapy for Pneumonia in the Neonatal Intensive Care Unit (NICU): Is 5 Days Enough?

Poster Number: 547
Publication Number: 547.428

Zachery S. Lewald, Nationwide Children's Hospital, Delaware, OH, United States; Pavel Prusakov, Nationwide Children's Hospital, Columbus, OH, United States; Jacqueline K. Magers, Nationwide Children's Hospital, Columbus, OH, United States; Matthew Kielt, Nationwide Children's Hospital, Columbus, OH, United States; Pablo J. Sanchez, Nationwide Children's Hospital -OSU, Columbus, OH, United States

Background: Antibiotic therapy provided to infants in the NICU is associated with both short and long term adverse consequences. In 2019, the Neonatal Antimicrobial Stewardship Program (NEO-ASP) at Nationwide Children’s Hospital (NCH), Columbus, OH, recommended a five day antibiotic course with a time-out for treatment of pneumonia in the seven NCH network NICUs.

Objective: To determine the duration of antibiotic therapy for pneumonia after implementation of a 5 day antibiotic treatment course and describe its safety among infants in the NICU

Design/Methods: Prospective surveillance of antibiotic therapy provided to infants in 7 NCH NICUs (1, level 4; 5, Level 3; 1, level 2) who were diagnosed with pneumonia by the attending neonatologist based on clinical and radiographic abnormalities from 8/2020 to present. Pertinent clinical, laboratory, and microbiologic data were obtained from electronic health records. Infants were excluded if they had positive bacterial cultures of blood, urine, or cerebrospinal fluid. The length of therapy (LOT) was defined as any calendar day that the infant received ≥1 antibiotic while definitive treatment course was the duration of appropriate antibiotic therapy. Safety was defined a priori by re-initiation of antibiotic therapy within 14 days after discontinuation of the initial treatment and/or mortality (overall/sepsis-related).

Results: Since 8/2020, NICU infants (66% male) were diagnosed with 115 episodes of pneumonia at a median (IQR) age of 2 (1-20) days. All had sterile cultures of blood, urine, and cerebrospinal fluid, if performed. Their median (IQR) birth weight and gestational age were 2695 (1075-3432) g and 36 (28-38) wk (≤28 wk, 30%; 29-33 wk, 12%; 34-36 wk, 15%; ≥37 wk, 49%), respectively. At the time of pneumonia diagnosis, 49% of infants were receiving CPAP while 44% were on mechanical ventilation (10% high frequency oscillatory ventilation). The median (IQR) LOT was 6 (5-6) days and length of definitive treatment was 5 (5-6) days. Overall mortality was 7% (8/109) with 50% of deaths being sepsis-related (n=4; Table 1). The majority of pneumonia episodes (88%; n=101) were treated with 5 days of definitive antibiotic therapy and 18 (16%) episodes had antibiotics restarted within 14 days (Table 1). There was no significant difference in the composite safety outcome between ≤5 vs. 6-9 days of definitive antibiotic therapy (p=0.32).Conclusion(s): There was excellent adherence (88%) to the NEO-ASP recommendation of a 5 day definitive treatment course for pneumonia and in addition, the intervention seemed safe.
Table 1. Safety assessments of definitive antibiotic treatment for 115 pneumonia episodes in 109 infants.*One infant had two pneumonia episodes with the first one treated for 5 days and the 2nd one treated for 8 days.
+1, methicillin-susceptible Staphylococcus aureus; 1, Pseudomonas aeruginosa
NEC, necrotizing enterocolitis