Reducing Antibiotic Exposure in Suspected Neonatal Sepsis

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Clinical Pharmacology

Background:

• Prolonged antibiotic use in preterm infants is linked to antimicrobial resistance and increased mortality.
• Early-onset sepsis evaluation often involves extended antibiotic courses, even with negative cultures.
• Need for strategies to optimize antibiotic duration and reduce unnecessary interventions in neonatal sepsis.

Purpose of the Study:

• To assess the impact of an automatic stop order (ASO) and C-reactive protein (CRP) measurement on antibiotic duration.
• To evaluate changes in the level of intervention, such as lumbar punctures, following these interventions.
• To reduce avoidable antibiotic exposure in preterm infants screened for early-onset sepsis.

Main Methods:

• A quasi-experimental study design with 4 time periods between 2011 and 2014.
• Introduction of an ASO for low-risk infants, then for all infants treated for suspected sepsis.
• Implementation of a single CRP measurement at 36 hours for infants with negative sepsis cultures.

Main Results:

• The proportion of infants receiving ≤48 hours of antibiotics increased from 19% to 72.5% (P < .0001).
• Avoidable antibiotic doses (>48 hours and <5 days) decreased from 50% to 0.8% (P < .0001).
• Lumbar puncture rates reduced from 35% to 20% (P = .015) with ASO implementation.

Conclusions:

• Automatic stop orders and CRP monitoring are effective in reducing unnecessary antibiotic exposure in neonates.
• These interventions significantly shorten antibiotic duration for infants with negative sepsis evaluations.
• Optimized antibiotic stewardship decreases invasive procedures and potential adverse outcomes in preterm infants.