Decreasing Antibiotic Use in a Community Neonatal Intensive Care Unit: A Quality Improvement Initiative.

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Quality Improvement Science

Background:

• Excessive antibiotic use in neonatal intensive care units (NICUs) poses risks to infant health and contributes to antibiotic resistance.
• A baseline antibiotic use rate (AUR) of 22% was identified as a concern in the NICU.

Purpose of the Study:

• To implement a multidisciplinary quality improvement (QI) initiative to decrease the antibiotic use rate (AUR) in a neonatal intensive care unit (NICU).
• The specific aim was to reduce the AUR from 22% to 17% over a 5-year period.

Main Methods:

• A 5-year QI initiative was conducted in a 53-bed level 3B NICU, incorporating core elements of antibiotic stewardship.
• Strategies included developing evidence-based guidelines, daily stewardship rounds, a sepsis risk calculator, and antibiotic stop orders.
• Statistical process control using P charts monitored the quarterly AUR.

Main Results:

• The initiative achieved a sustained decline in AUR, reaching 13.18% by the end of the study period.
• This represents a 40% decrease from the baseline AUR of 22%.
• Implemented changes included evidence-based guidelines, daily stewardship rounds, sepsis risk calculator, and antibiotic stop orders.

Conclusions:

• A multidisciplinary approach integrating core antibiotic stewardship elements effectively decreased AUR in the NICU.
• This initiative demonstrates the success of QI programs in optimizing antibiotic use in vulnerable neonatal populations.
• Reduced antibiotic exposure is crucial for preventing harm and combating resistance in neonates.