220 - Decreasing Unnecessary Antibiotic Exposure in Post-Surgical Neonates: A Quality Improvement Initiative

Poster Number: 220
Publication Number: 220.127

Megan McGowan, Wake Forest Baptist Health - Brenner Children's Hospital, Greensboro, NC, United States; Cherrie Welch, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States; Modupeola Akinola, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Taysha T. Cerisier, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Austell, GA, United States; Devon Davis, Wake Forest Baptist Health - Brenner Children's Hospital, Burlington, NC, United States

Background: Neonates are sometimes exposed to unnecessary antibiotics due to concerns for increased risk of infection related to immature immune systems. Studies have shown that prolonged, unnecessary antibiotic exposure in the newborn is associated with adverse consequences such as antibiotic resistance and antibiotic-induced microbiome alterations, increasing the risk of immune-related diseases in childhood. Reduction in antibiotic use in neonates with suspected early onset sepsis has been achieved by quality improvement studies but there is a lack of antibiotic stewardship related to type and duration in surgical infants.

Objective: Our study aim was to decrease unnecessary post-operative antibiotic exposure in surgical neonates by implementing standardized post-operative antibiotic guidelines.

Design/Methods: Post-IRB approval, a multidisciplinary healthcare team developed and implemented post-operative antibiotic guidelines. Baseline data was collected through retrospective chart review of neonates undergoing the following surgical procedures: gastroschisis repair, intestinal atresia repair, necrotizing enterocolitis (NEC) procedure, spontaneous intestinal perforation (SIP) procedure, and gastrostomy tube placement, between January 2017 and June 2020. Retrospective and prospective data collection included an infant’s gestational age, sex, birth weight, race, antibiotic type and duration, and reasons for guideline deviation (prospective data). Guideline compliance monitoring is ongoing using Plan-Do-Study-Act (PDSA) cycles.

Results: Of 134 neonates that had one of the surgical procedures of interest, 23 infants with gastroschisis repair had a median post-operative antibiotic duration (POAD) of 2 days (range 0-7 days); 25 infants with intestinal atresia repair had a median POAD of 1 day (range of 0-5 days); 37 infants had NEC procedures with median POAD of 5.5 days (range 1-14 days); 30 infants had SIP procedures with median POAD of 7 days (range 1-23 days); 49 infants had gastrostomy tubes placed with median POAD of 2 days (range 0-10 days) (Figure1). Concordance with current guidelines prior to their implementation demonstrates wide variability (0-80%), depending on procedure (Figure 2).Conclusion(s): Baseline retrospective data demonstrated variability in antibiotic type (data not supplied) and duration in post-surgical neonates even within the same surgical procedure. Next steps include monitoring guideline compliance to determine the need for any modification and additional provider education.
CV for Megan McGowan, MDMeganMcGowan_MD.pdf
Concordance with Current Guidelines Prior to ImplementationPercent concordance with current post-operative antibiotic guidelines prior to their implementation for neonates who underwent abdominal surgical procedures between 2017 and 2020.