Reducing Antibiotic Use for Culture-Negative Sepsis in a Level IV Neonatal Intensive Care Unit

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Quality Improvement Science

Background:

• Antibiotic overuse for suspected infections without a clear source is common in neonatal intensive care units (NICUs).
• Prolonged antibiotic exposure in neonates increases risks of late-onset sepsis, mortality, and multidrug-resistant organisms.
• Reducing unnecessary antibiotic use for culture-negative sepsis (CNS) is a critical objective in neonatal care.

Purpose of the Study:

• To decrease antibiotic utilization for culture-negative sepsis (CNS) in a level IV NICU.
• To implement targeted interventions aimed at reducing the number and duration of antibiotic courses for CNS.
• To improve antibiotic stewardship practices within the neonatal intensive care setting.

Main Methods:

• A quality improvement project utilizing the Model for Improvement with Plan-Do-Study-Act cycles.
• Implementation of Antibiotic Guidelines, case audits, and regular antibiotic stewardship rounds.
• Systematic review of CNS cases and antibiotic use metrics, including days of therapy (DOTs) per 1000 patient days (PDs).

Main Results:

• Antibiotic DOTs for CNS decreased by 81% post-intervention.
• A significant reduction in early-onset sepsis DOTs was observed (18.3 to 3.9 DOTs/1000 PDs).
• Overall unit antibiotic DOTs decreased from 232.5 to 176.7 DOTs/1000 PDs, with no adverse impact on balancing measures.

Conclusions:

• A quality improvement initiative effectively reduced antibiotic use for CNS in a level IV NICU.
• Prioritizing case review and stewardship rounds enhanced guideline adherence and minimized unnecessary antibiotic treatment.
• The study demonstrates a successful strategy for optimizing antibiotic stewardship in neonatal intensive care settings.