Optimizing antibiotic use for early onset sepsis: A tertiary NICU experience

Area of Science:

• Neonatal Medicine
• Infectious Disease
• Healthcare Quality Improvement

Background:

• Neonatal antibiotic use increases risks of infection, necrotizing enterocolitis, and mortality.
• It can also lead to drug-resistant pathogens, raising healthcare costs and length of stay.
• Before stewardship, antibiotic decisions for Early-onset Sepsis (EOS) were provider-dependent, not algorithm-based.

Purpose of the Study:

• To decrease empiric antibiotic prescription in infants ≥34 weeks gestation admitted to the NICU by 20% (from 70% to 56%).
• To implement an antibiotic stewardship program utilizing the Neonatal Sepsis Risk Calculator (SRC) and a 36-hour antibiotic time-out.

Main Methods:

• Retrospective analysis of inborn infants pre-intervention (n=263) and post-intervention (n=279).
• Implementation of the Neonatal Sepsis Risk Calculator (SRC) and a 36-hour empiric antibiotic time-out.
• Weekly dissemination of compliance data to the NICU team.

Main Results:

• Significant reduction in antibiotic prescriptions (49.6% vs. 70.3%, p<0.001) and sepsis evaluations (68.8% vs. 90.9%, p<0.001).
• No significant difference in culture-positive EOS cases (p=0.271).
• High overlap (92-95%) between SRC recommendations and CDC guidelines.

Conclusions:

• The stewardship initiative successfully reduced antibiotic use and sepsis evaluations in neonates.
• No clinical deterioration was observed in infants not receiving antibiotics post-intervention.
• The SRC demonstrates significant concordance with current CDC guidelines for neonatal sepsis evaluation.