Abstract
Background
Clinical practice surrounding neonatal sepsis varies significantly among physicians. In efforts to confront the challenge of inappropriate and overuse of antimicrobials in our Neonatal Intensive Care Unit (NICU), a multidisciplinary team developed a guideline for the evaluation and management of suspected and proven sepsis within the NICU in preterm infants. We evaluated the antimicrobial utilization before and after the implementation of our guideline, developed in July 2018.
Methods
All infants <37 gestational weeks born in July and August of 2016, 2017, and 2018 were retrospectively reviewed and compared before and after implementation of the guideline. The primary outcome was the percentage of antibiotic-free days per admission. Secondary outcomes include percentage of directive treatment courses and percentage of antibiotic days for culture-negative sepsis. Chi-square and Mann–Whitney U tests were performed, as appropriate.
Results
A total of 75 and 37 patients were included for preliminary data analysis in the pre- and post-implementation periods, respectively. Chi-square and Mann–Whitney U tests were performed, as appropriate. The percentage of antibiotic-free days per admission per patient born in the pre-implementation period was lower (84.4% vs. 86.5%, P = 0.028). There is no statistical difference in the percentage of directive treatment between the two groups. The percentages of culture-negative antibiotic days were not statistically significant (69.2% vs. 80.5%, P = 0.296). The average birth weights were lower (1,719.7 grams vs. 1,420.7 grams, P = 0.02) and gestational ages were younger (31.4 weeks vs. 29 weeks, P = 0.001) in the post-implementation period.
Conclusion
Our preliminary data did not show a significant decline in the percentage of antibiotic-free days or culture-negative antibiotic days after the implementation of our guideline; however, this may be confounded by the differences noted in our patient populations and is based on preliminary data. Implementation of this guideline is feasible and may reduce the inappropriate use of antimicrobials. Further data collection is ongoing to fully assess the impact of this guideline.
Disclosures
All authors: No reported disclosures.
Session: 139. Antibiotic Stewardship (Pediatric): Implementation in Hospitals
Friday, October 4, 2019: 12:15 PM