219 - Creation and Implementation of a Standardized Antimicrobial Use and Sepsis Evaluation Guideline across a Regional Network of NICUs

Poster Number: 219
Publication Number: 219.127

Alaina Pyle, Connecticut Children's Medical Center, Monroe, CT, United States; Usha Prasad, University of Connecticut School of Medicine, Hartford, CT, United States; Nancy A. Louis, CCSG, Glastonbury, CT, United States; Jennifer E. Girotto, University of Connecticut, Hartford, CT, United States; Hassan El Chebib, Connecticut Children's Medical Center, Hartford, CT, United States; J. Leslie Knod, Connecticut Children's Medical Center, hartford, CT, United States; Brett V. Citarella, UCONN School of Medicine, Old Saybrook, CT, United States; David Sink, Connecticut Children's Medical Center, West Hartford, CT, United States; Allison Sadowski, Connecticut Children's Medical Center, Newington, CT, United States; Annmarie Golioto, Connecticut Children's, Hartford, CT, United States

Background: Antibiotics are the most prescribed medication in the neonatal intensive care unit (NICU) and can have serious consequences, including antimicrobial resistance, and increased risk of sepsis, NEC, and death. Optimizing antibiotic use through implementation of a guideline across multiple sites within a network can be challenging due to practice variation and limited discussion between providers.

Objective: To optimize antibiotic use and improve care by implementation of a standardized guideline across multiple sites within a network of NICUs.

Design/Methods: A multidisciplinary inter-hospital antimicrobial stewardship (ASP) workgroup developed an antimicrobial use and sepsis evaluation guideline, based on local expert consensus and literature review. This included representatives from NICU, Infectious Disease (ID), Pharmacy, and Pediatric Surgery, with physicians, nurses, and APPs from seven Level 2-4 centers. Recommendations include specific antibiotic type and duration by indication, 36-hour empiric antibiotics, Neonatal Sepsis Calculator use, and best practices for central lines. This guideline was added to a free electronic app containing other institutional ID guidelines. Education was provided verbally and in writing for the teams at each of the 7 participating hospitals. Feedback was incorporated in stepwise fashion after review by the primary committee. Data was collected retrospectively for a range of 15-28 months and prospectively 04/2021-12/2021, using chart review and the Vermont Oxford Network database. We obtained demographics, relevant maternal data, and morbidities such as ventilator days, NEC, surgeries, and length of stay. The key metrics are days of therapy (DOT), antibiotic type, bacterial culture results, and central line days.

Results: The development of this guideline has created a standardized practice for antibiotic use and improved communication between specialties and across hospitals in a regional network. High acceptance of education and resources was seen with app metrics showing the guideline being accessed a median 14 times (IQR 1-24) per day. A database was developed for each site with individual level data on ~3200 patients from 2019-2021, as well as monthly antibiotic use by unit as DOT/1000 patient days.Conclusion(s): Antimicrobial stewardship is a critical component of NICU care. Standardizing evaluations and optimizing antibiotic use provides consistency, and improves communication and care in the short and long-term. Unifying multiple disciplines in academic and community-based NICU’s within a regional network will foster optimal care for all at-risk newborns.