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Risk Stratification to Support Antibiotic Stewardship and Breastfeeding Exclusivity in a Military Treatment Facility
Insights
Implementing an early-onset sepsis (EOS) calculator and shortening antibiotic duration safely reduced antibiotic exposure in neonates. This initiative also significantly increased exclusive breastfeeding rates before discharge.
Area of Science:
- Neonatal care
- Infectious disease management
- Quality improvement initiatives
Background:
- Neonatal exposure to chorioamnionitis or inadequate Group B Streptococcus (GBS) treatment often leads to unnecessary antibiotic use.
- Lack of standardized risk assessment for early-onset sepsis (EOS) contributes to over-prescription of antibiotics in neonates.
Purpose of the Study:
- To reduce unnecessary antibiotic exposure in neonates at risk for EOS.
- To implement a risk stratification tool and a standardized antibiotic duration protocol.
- To improve breastfeeding outcomes in a specific neonatal population.
Main Methods:
- A quality improvement initiative was conducted at a military treatment facility.
- An interdisciplinary team implemented the EOS calculator and a 36-hour antibiotic duration protocol.
- Staff education and electronic health record integration supported the protocol.
Main Results:
- Antibiotic exposure in neonates exposed to chorioamnionitis or inadequate GBS treatment decreased from 97.6% to 32%.
- Exclusive breastfeeding rates at discharge increased from 40% to 89% in the studied neonates.
- No readmissions for culture-proven sepsis within 14 days of discharge were recorded post-implementation.
Conclusions:
- Multidisciplinary implementation of the EOS calculator and shortened antibiotic duration safely reduced antibiotic exposure.
- The initiative led to significantly improved exclusive breastfeeding rates in neonates exposed to chorioamnionitis and GBS.
- This approach demonstrates a successful strategy for optimizing neonatal care and antibiotic stewardship.
Objective:
To safely reduce unnecessary antibiotic exposure in neonates exposed to chorioamnionitis and inadequately treated Group B Streptococcus (GBS) using the early-onset sepsis (EOS) calculator for risk stratification and a 36-hour antibiotic duration.
Design:
Evidence-based quality improvement initiative.
Setting/Local Problem:
Obstetric service at a midsized military treatment facility with approximately 2,000 births annually and no standard process for neonatal EOS risk assessment.
Participants:
Clinical nurse specialist, physicians, nursing leadership, unit-level nursing champions, and nurses assigned to the mother-baby and labor and delivery units.
Intervention/Measurements:
An interdisciplinary working group created a protocol to institute an EOS risk assessment calculator, a note for the electronic heath record, and interdisciplinary education for all staff providing care to neonates in our facility.
Results:
Before implementation of the EOS calculator, 97.6% of neonates exposed to chorioamnionitis or inadequate maternal GBS treatment received antibiotics; after implementation, the mean rate dropped to 32%. Exclusive breastfeeding rates before discharge in neonates exposed to chorioamnionitis or inadequate maternal GBS treatment also increased during this time, from 40% to a mean of 89%. After implementation, there were no readmissions to our institution for culture-proven sepsis within 14 days of discharge.
Conclusion:
Multidisciplinary team-led implementation of the EOS calculator and of shortened antibiotic duration were associated with safely reduced antibiotic exposure in well-appearing neonates exposed to chorioamnionitis and GBS. In addition, dramatically improved rates of exclusive breastfeeding at discharge were observed in this population.
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