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Implementation of an Automatic Stop Order and Initial Antibiotic Exposure in Very Low Birth Weight Infants

Veeral N Tolia1, Sujata Desai1, Huanying Qin2

  • 1Division of Neonatology, Department of Pediatrics, Baylor University Medical Center and Pediatrix Medical Group, Dallas, Texas.

American Journal of Perinatology
|June 11, 2016
PubMed

Insights

An antibiotic automatic stop order (ASO) significantly reduced early antibiotic exposure in very low birth weight (VLBW) infants. This guideline change did not impact infant mortality or morbidity rates.

Area of Science:

  • Neonatal Medicine
  • Pediatric Infectious Diseases
  • Clinical Pharmacy

Background:

  • Early antibiotic exposure in very low birth weight (VLBW) infants is associated with adverse outcomes.
  • Antibiotic stewardship programs aim to optimize antimicrobial use in vulnerable populations.
  • The impact of antibiotic automatic stop orders (ASOs) on neonatal antibiotic exposure and outcomes requires evaluation.

Purpose of the Study:

  • To assess the effect of an antibiotic automatic stop order (ASO) on early antibiotic exposure in VLBW infants.
  • To determine if ASO implementation influenced clinical outcomes, including morbidity and mortality, in VLBW infants.

Main Methods:

  • A comparative study design was used, analyzing VLBW infants (<1500g) before and after ASO guideline implementation.
  • Early antibiotic exposure was measured by days of therapy (DOT) and duration of use (>48 hours).
  • Clinical outcomes, including mortality, early mortality, early onset sepsis (EOS), and necrotizing enterocolitis, were compared between groups.

Main Results:

  • Median antibiotic exposure decreased from 6.5 DOT (pre-ASO) to 4 DOT (post-ASO) (p < 0.001).
  • The percentage of infants receiving antibiotics for >48 hours significantly reduced post-ASO (63.4% vs. 41.3%, p < 0.001).
  • No significant differences were observed in overall mortality, early mortality, or other morbidities between the groups.

Conclusions:

  • Implementation of an antibiotic automatic stop order effectively reduced early antibiotic exposure in VLBW infants.
  • The reduction in antibiotic exposure was achieved without adversely affecting key clinical outcomes.
  • ASOs represent a viable strategy for antibiotic stewardship in the neonatal intensive care unit.

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