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Healthcare Associated Infections II: Preventive Measures01:22

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Updated: May 26, 2025

A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
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Reducing Antibiotic Use for Culture-Negative Sepsis in a Level IV Neonatal Intensive Care Unit.

Jessica M Lewis1, Laura Nell Hodo1, Jennifer Duchon1

  • 1Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.

Pediatrics
|February 25, 2025
PubMed
Summary

Neonatal intensive care units (NICUs) reduced antibiotic use for culture-negative sepsis (CNS) by 81% through quality improvement initiatives. This involved guideline adherence and stewardship rounds, decreasing overall antibiotic exposure in neonates.

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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.