PC1255: Plot the Dots: Antibiotic Stewardship in the NICU

Purpose/Objectives: Antibiotic stewardship in the critical care setting where infections can increase mortality and worsen outcomes is crucial. Infants admitted to the NICU are particularly susceptible and judicious use of antibiotics may prevent the development of resistant infections and of many neonatal comorbidities associated with prolonged exposure. We will assess adherence to a new antibiotic use algorithm implemented September 2021 for sepsis evaluations in infants >72 hours of life in the NICU with a goal to decrease days of antibiotic therapy (DOT) by 20% within 6 months of implementation.

Design/Methods: A protocol for late onset sepsis evaluation in neonates in the NICU was implemented in September 2021. A retrospective chart review for sepsis workups > 3 days of life (DOL) in infants (epoch 1) was used to obtain baseline adherence and DOT rates. Charts were then examined through PDSA cycles: epoch 2 (October-December 2021) and epoch 3 (January-March 2022). Barriers to implementation were addressed in January 2022. An electronic medical record smartphrase was implemented by neonatal perinatal medicine fellows in February 2022 and extended to residents in March 2022.

Results: Epoch 1 consisted of 35 sepsis evaluations on 25 infants with 60% of evaluations occurring ≥15 DOL. Protocol adherence was 68.5% with 28.5% positive cultures and a mean DOT of 7.42 ± 5.8 days. Epoch 2 consisted of 37 sepsis evaluations on 25 infants with 76% of workups occurring ≥15 DOL. Protocol adherence was 81.1% with 43.2% positive cultures and a mean DOT of 7.09 ± 5.1 days. PDSA cycles revealed barriers including inconsistent documentation regarding prolonged exposure and protocol deviations. These barriers were addressed with an electronic medical record smartphrase to document all sepsis evaluations. In epoch 3, there were 27 sepsis evaluations on 22 infants with 85% of evaluations occurring ≥15 DOL. Protocol adherence was 85.1% with 40.7% positive cultures and a mean DOT of 5.39 ± 6.58 days. There was a 17% improvement in protocol adherence and a decrease in DOT when the protocol was followed.

Conclusion/Discussion: There was a significant improvement in protocol adherence and reduction in DOT. Additional quarterly assessments will be performed to determine if protocol adherence measures can be sustained. We will continue to focus on reduction of prolonged antibiotic exposure, especially in the context of negative cultures.