New Studies Detail Efforts to Reduce Antibiotic Use in NICUs

Two new studies published last week in Pediatrics describe efforts to “reduce antibiotic use in neonatal intensive care units (NICUs).” CIDRAP has the news.

NICUs have “become a focus for stewardship advocates in recent years because antibiotics are among the most frequently prescribed drugs in these units, and prolonged antibiotic use is common.” Excessive antibiotic use in NICUs has been associated with “a range of harms, including disruption of the developing gut microbiome, development of resistant organisms, increased risk of childhood allergies, necrotizing enterocolitis, and late-onset sepsis.” The interventions studied were focused on reducing antibiotic use for culture-negative sepsis.

The first study looks at an antibiotic stewardship quality improvement (QI) initiative in the NICU at St. Christopher’s Hospital for Children in Philadelphia. The initiative “included development of consensus guidelines on recommended durations for four common indications—culture-negative sepsis (5 days), rule-out sepsis (2 days), tracheitis (5 days), and uncomplicated pneumonia (7 days).” The researchers examined “antibiotic use data on 522 newborns exposed to at least one antibiotic in the NICU. Of those newborns, 137 were treated prior to the intervention (January through December 2019), and 450 were treated postintervention (January 2020 through December 2023). Comparison of the preintervention and postintervention prescribing practices showed that the percentage of antibiotic courses attributed to culture-negative sepsis declined from 13% to 7%, with early-onset culture-negative sepsis diagnoses falling from 9% to 4%.”

The second study examined a QI initiative aimed to “reduce the number of treatment courses for culture-negative sepsis by 30% and treatment duration by 25%.” Interventions included “creation of antibiotic guidelines for suspected sepsis, case audits, weekly antibiotic stewardship rounds, and biweekly review of culture-negative sepsis cases at staff meetings.” The researchers found that “antibiotic DOTs for culture-negative sepsis fell by 81%” from pre- to post-intervention. The authors said that “the provider behavior changes that made the intervention successful were reinforced by educational sessions, literature review, and clinical consensus discussions. But the changes were sustained by the development of antibiotic guidelines, stewardship rounds, and regular review of data.”