A Collaborative Multicenter QI Initiative to Improve Antibiotic Stewardship in Newborns

Area of Science:

• Neonatal Intensive Care Unit (NICU) care
• Infectious disease management
• Public health initiatives

Background:

• Antibiotic resistance is a growing global health concern.
• Optimizing antibiotic use in Neonatal Intensive Care Units (NICUs) is critical for patient outcomes and combating resistance.
• The Centers for Disease Control and Prevention (CDC) established core elements for effective antibiotic stewardship programs.

Purpose of the Study:

• To evaluate the impact of a multicenter quality improvement (QI) collaborative on NICU teams' adherence to CDC antibiotic stewardship core elements.
• To assess whether participation in the collaborative leads to a reduction in antibiotic use (AU) in neonatal populations.

Main Methods:

• 146 NICUs participated in the "Choosing Antibiotics Wisely" QI collaborative from January 2016 to December 2017.
• The collaborative utilized interactive web sessions, point-prevalence audits, and expert coaching.
• Audits measured adherence to CDC core elements and collected data on infant antibiotic exposure.

Main Results:

• Significant increases in NICU adherence were observed across all seven CDC core element domains (e.g., leadership, accountability, education).
• The median antibiotic use rate in NICUs decreased by 34%, from 16.7% to 12.1% during the study period.
• These improvements were statistically significant (P < .005 for core elements, P < .0013 for antibiotic use trend).

Conclusions:

• Multicenter QI collaboratives can effectively enhance NICU teams' implementation of antibiotic stewardship principles.
• Participation in such initiatives demonstrably reduces antibiotic use in vulnerable newborn populations.
• These findings support the widespread adoption of QI collaboratives for improving antibiotic stewardship in NICUs.