Adherence of Newborn-Specific Antibiotic Stewardship Programs to CDC Recommendations

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Healthcare Quality Improvement

Background:

• The Centers for Disease Control and Prevention (CDC) established Core Elements for Hospital Antibiotic Stewardship Programs (ASPs).
• The Choosing Wisely for Newborn Medicine initiative highlighted antibiotic therapy overuse in neonates.
• There is a need to understand the current state of newborn-specific ASPs and neonatal intensive care unit (NICU) antibiotic use.

Purpose of the Study:

• To determine the baseline prevalence and composition of newborn-specific ASPs.
• To assess the variability in antibiotic use rates (AURs) within NICUs.
• To evaluate adherence to CDC's Core Elements of ASPs in neonatal settings.

Main Methods:

• A cross-sectional audit of Vermont Oxford Network members was conducted in February 2016.
• Data collection involved assessing the 7 domains of the CDC's Core Elements of Hospital ASPs.
• Patient-level data and unit-level antibiotic use rates (AURs) were calculated.

Main Results:

• No participating center fully implemented all 7 core elements of ASPs; only accountability and drug expertise exceeded 50% compliance.
• The median hospital AUR was 17% (IQR 10%-26%), with 725 of 4127 audited infants receiving antibiotics.
• Of infants on antibiotics for >48 hours, only 26% had positive culture results confirming infection.

Conclusions:

• Substantial discrepancies exist between CDC recommendations and current antibiotic use practices in newborn care.
• Significant variability in point prevalence AURs was found across NICUs.
• A high proportion of neonates receiving extended antibiotic therapy (>48 hours) lacked microbiological evidence of infection.