Reducing antibiotic utilization rate in preterm infants: a quality improvement initiative

Area of Science:

• Neonatal Medicine
• Pediatric Infectious Diseases
• Quality Improvement Science

Background:

• Prolonged antibiotic use in preterm infants is linked to adverse outcomes.
• Overuse of antibiotics was identified in preterm infants with low sepsis suspicion.
• Antibiotic stewardship is crucial for vulnerable neonatal populations.

Purpose of the Study:

• To reduce antibiotic use in preterm infants.
• To implement a quality improvement initiative for antibiotic stewardship.
• To decrease the antibiotic utilization ratio (AUR) in a neonatal intensive care unit (NICU).

Main Methods:

• A quality improvement initiative was implemented using Plan-Do-Study-Act cycles.
• Guidance algorithms for sepsis evaluation and management were developed.
• Early discontinuation of antibiotics (36 hours) and multiplex PCR assays were key interventions.

Main Results:

• The overall antibiotic utilization ratio (AUR) decreased by 10.6% (154.8 to 138.4 days per 1000 hospital days).
• The reduction in AUR was statistically significant (p < 0.05).
• Adherence to the guidance algorithm remained below the target of 90%.

Conclusions:

• The quality improvement initiative successfully reduced antibiotic utilization in the NICU.
• The long-term benefits of decreased antibiotic exposure in preterm infants require further investigation.
• Optimizing adherence to antibiotic stewardship guidelines is essential.