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Published on: August 30, 2018
Impact of an antimicrobial stewardship intervention in neonatal intensive care: Recommendations and implementation
Paola Villanueva1,2,3, Bridget Freyne2,3,4,5, Leah Hickey2,3,6
1Department of General Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
Insights
A collaborative antimicrobial stewardship (AMS) intervention improved prescribing appropriateness in a neonatal intensive care unit (NICU). This audit-feedback approach significantly reduced inappropriate antibiotic use, enhancing patient care.
Area of Science:
- Neonatal Intensive Care Unit (NICU)
- Infectious Diseases
- Antimicrobial Stewardship (AMS)
Background:
- Antimicrobial prescribing in NICUs requires careful evaluation.
- Inappropriate antibiotic use poses risks to vulnerable neonates.
- Effective AMS interventions are crucial for optimizing treatment outcomes.
Purpose of the Study:
- To assess antimicrobial prescribing appropriateness in a NICU.
- To evaluate the impact of a collaborative AMS intervention on prescribing practices.
Main Methods:
- A 6-month, weekly audit-feedback AMS intervention involving Neonatology and Infectious Diseases clinicians.
- Real-time auditing of antibiotic prescriptions and delivery of recommendations.
- Assessment of recommendation implementation to gauge intervention acceptability.
Main Results:
- 23 AMS rounds reviewed 249 patients across 627 episodes; 233 episodes involved antimicrobials.
- Inappropriate antibiotic use occurred in 58 (25%) of 233 episodes.
- Following the intervention, appropriate antibiotic prescribing increased from 75% to 93% (P < 0.001).
Conclusions:
- A collaborative audit-feedback AMS intervention effectively identified and addressed inappropriate antimicrobial prescriptions in the NICU.
- The intervention positively impacted treatment plans and improved inter-departmental communication.
- Revision of antimicrobial prescribing guidelines was an ancillary benefit of the AMS program.
Aim:
To (i) determine the appropriateness of antimicrobial prescribing in the neonatal intensive care unit (NICU) and (ii) assess the impact of a collaborative antimicrobial stewardship (AMS) intervention on prescribing practices.
Methods:
The intervention was a weekly AMS audit-feedback joint ward round (6-month period) of Neonatology and Infectious Diseases clinicians in a tertiary neonatal intensive care unit in Melbourne, Australia. Antibiotic prescriptions were audited and recommendations delivered in real time. The proportion of recommendations implemented was used to assess acceptability of the intervention.
Results:
During the study period, there were 23 AMS rounds, during which 249 patients were reviewed at 627 separate episodes. Of these, 233 (37%) episodes were for patients receiving antimicrobials. Of these, 147 (63%) received empirical antimicrobial treatment, 43 (18%) targeted antimicrobial treatment and 43 (18%) antimicrobial prophylaxis. There were 58 (25%) of 233 episodes of inappropriate antibiotic use, and 62 recommendations for improvement. Most common recommendations were to narrow (33/62, 53%) or stop (12/62, 19%) antimicrobials. The majority (45, 73%) of recommendations were accepted, resulting in significant improvement in the proportion of the 233 episodes that had completely appropriate antibiotic prescribing: 175 (75%) to 217 (93%) (relative risk 1.2, 95% confidence intervals 1.1-1.3, P < 0.001).
Conclusions:
A collaborative audit-feedback AMS intervention was effective in identifying inappropriate antimicrobial prescriptions and impacted positively on treatment plans. Ancillary benefits were improved communication between departments and the revision of antimicrobial prescribing guidelines.
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