560 - Implementation of a Network-Wide Antibiotic Stewardship Quality Improvement Initiative Improved Site-Specific Compliance with Pre-existing Antibiotic Usage Guidelines at a Level 3 Participating NICU

Poster Number: 560
Publication Number: 560.336

Alaina Pyle, Connecticut Children's Medical Center, Monroe, CT, United States; Nancy A. Louis, CCSG, Glastonbury, CT, United States

Background: Antibiotics (ABX), although critical tools in the newborn intensive care unit (NICU), also alter microflora, gut barrier and general health. Early onset sepsis (EOS) remains a significant threat to NICU patients; yet, concern for ABX-associated adverse effects (e.g. NEC and death) warrants decreased empiric ABX during EOS evaluations. For our 15-bed Level 3 NICU, coverage derives from a mix of site-based providers and rotating physicians from our larger network. From 2019 to 2020, site-based providers promoted limitation of ABX in culture negative (Cx-) EOS evaluations to 36 hours (hr) with variable success. In late 2020, a multi-disciplinary task force (NICU ASP) created literature and expert consensus-based guidelines to unify ABX use and sepsis evaluations across the network.

Objective: The impact of new NICU ASP guidelines on the length of empiric ABX during EOS evaluations was assessed.

Design/Methods: In March 2021, the NICU ASP consensus guidelines were adopted, promoting a shift from 48 to 36hr of ABX during EOS evaluation. Data was collected by retrospective chart review and interrogation of the Vermont Oxford Network database, for 27 months pre- and 9 months post-implementation, with duration of ABX therapy represented as days of therapy (DOT), such that 36hr of therapy with ampicillin and gentamicin equals 3 DOT and 48hr is 4 DOT. Patients with culture proven sepsis, NEC, UTI, cellulitis, or omphalitis, and those transferred out prior to 48hr were excluded.

Results: Following implementation of the NICU ASP guideline, the percent of treated patients receiving > 36hr antibiotic declined from 85.4%+8.5  to 55.1%+3.9(p-value < 0.007) with an associated decrease in the DOT/treated patient from a mean of 4.0+0.5 to 3.0+0.3 days (p-value 0.16). While this decrease was not statistically significant across all patients, analysis of term ( >=37 weeks) vs. preterm (28-36 6/7 weeks) infants revealed that decrease in DOT/treated patients from a mean of 3.5+0.1 to 3.0+0.05 days was significant for preterm infants (p-value 0.006), while the decrease in mean DOT/treated patients from 5.0+1.5 to 3.0+0.8 days (p-value 0.28) for term patients was not. The DOT for EOS evaluations varied more in term infants due to a subset of patients treated for pneumonia in the context of prolonged respiratory failure.
 Conclusion(s): Implementation of a network wide NICU ASP consensus guideline significantly increased compliance with a 36hr course for ABX therapy during EOS evaluation in this Level 3 unit. This was accompanied by a decrease in DOT/treated patient which was more consistent in preterm than term infants.

Implementation of a Network-wide, Multidisciplinary Antibiotic Stewardship Guideline Improves Compliance with An Initiative to Shorten Duration of Antibiotic Therapy During Evaluation for Early Onset Sepsis
<img src=https://www.abstractscorecard.com/uploads/Tasks/upload/16020/FGOVBGGC-1181331-2-IMG.jpg width=440 hheight=413.384813384813 border=0 style=border-style: none;>Figure 1:
A. Percent of patients who received the goal of 36hr antibiotics rather than a longer course, pre versus post guideline implementation. Error bars represent S.E.M. (p value = 0.006).
B. Days of therapy (DOT) with ampicillin plus gentamicin, pre and post guideline implementation which is not statistically significant.
C. (Preterm, 28-36 6/7 weeks and D. (Term, >=37 weeks) DOT per treated patient pre and post implementation of the NICU ASP Guidelines, which reached statistical significance for preterm but not term infants.