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Implementation of an Antimicrobial Stewardship Program in a Neonatal Intensive Care Unit.

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Implementing an antimicrobial stewardship program in a neonatal intensive care unit (NICU) improved antibiotic prescribing practices. While overall antibiotic use did not significantly decrease, ampicillin use and late-onset sepsis evaluations were significantly reduced.

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Area of Science:

  • Neonatal Intensive Care Unit (NICU)
  • Infectious Diseases
  • Public Health

Background:

  • Antimicrobial resistance poses a significant threat to patient care, particularly in vulnerable neonatal populations.
  • Neonatal intensive care units (NICUs) are high-risk environments for the development and spread of infections.
  • Effective antimicrobial stewardship programs (ASPs) are crucial for optimizing antibiotic use and combating resistance.

Purpose of the Study:

  • To evaluate the impact of a NICU-specific antimicrobial stewardship program (ASP) on antimicrobial utilization and prescribing practices.
  • To assess changes in antibiotic therapy days and prescription events for specific infections.
  • To determine the feasibility and effectiveness of implementing an ASP in a level IV NICU.

Main Methods:

  • A quasi-experimental, interrupted time-series study design was employed.
  • Data were collected on all neonates prescribed antimicrobials over a five-year period (January 2011-June 2016).
  • The study focused on prescriber audit and feedback, guideline development, and analysis of antibiotic days of therapy (DOT) and prescription events.

Main Results:

  • Overall antibiotic utilization showed a non-significant decrease of 14.7 DOT per 1,000 patient days.
  • Ampicillin use, a common NICU antimicrobial, significantly decreased by 22.5 DOT per 1,000 patient days (P=.037).
  • Late-onset sepsis evaluations and prescriptions significantly decreased (P<.0001), with high guideline compliance (98.75%).

Conclusions:

  • Implementation of a NICU-specific ASP is feasible and demonstrates potential for improving antibiotic prescribing.
  • Targeted interventions within an ASP can lead to significant reductions in specific antimicrobial use and diagnostic evaluations.
  • ASPs are essential for optimizing antimicrobial use in neonatal populations and mitigating resistance.