Evaluating the effectiveness of a vancomycin stewardship programme in a level IV neonatal intensive care unit

Despite recommendations to limit the use of vancomycin for known resistant infections, it remains one of the most commonly prescribed antibiotics in neonatal intensive care units (NICUs). One of the most effective approaches to reducing unnecessary antibiotic exposure is through the implementation of antibiotic stewardship programmes (ASPs).

The objective of this study was to evaluate the effectiveness of ASPs in reducing the use of vancomycin in neonates hospitalized in our NICU.

This study was a quasi-experimental single-centre study for a quality improvement (QI) initiative. Interventions were implemented to limit the use of vancomycin, including education of the neonatal intensive care team, standardization of vancomycin therapy, and prospective audit and feedback. The pre-intervention period was compared with the post-intervention period.

The initiation of vancomycin decreased from 166 times in the pre-intervention period to 71 times after stewardship implementations, representing a 57.2% reduction. Total vancomycin days of therapy per 1000 patient days gradually declined from 113 to 45 (60.2%) (P<0.001) during the study period. There was an increase in the Gram-positive growth in the culture of patients who were started on vancomycin (P=0.04). The number of patients receiving two or more courses of vancomycin treatment decreased by 85.7% (P=0.03).

This study has demonstrated that implementing effective multi-disciplinary strategies can significantly reduce vancomycin exposure in the NICU. The application of ASP practices and management in the NICU is essential and achievable, without any increase in the duration of hospitalization or mortality rates.