Table 1.

Major Antibiotic Stewardship Interventions

1. Created a multidisciplinary neonatal intensive care unit-specific ATB stewardship team composed of a neonatologist, infectious disease physician, infection control specialist, quality specialist, pharmacist, APP, frontline nursing and respiratory staff, and nursing leadership.

2. Educated on and standardized use of the Centers for Disease Control and Prevention algorithm refined with recommendations from the Committee on Fetus and Newborn from 2010 to 2014 in conjunction with use of the neonatal early-onset sepsis calculator for every birth 34 weeks and older GA. This latter step reassured neonatologists/APPs and pediatricians that sepsis workups and ABX are often not indicated, and in the majority of cases it is safe to observe asymptomatic newborns without starting ABX.

3. Established culture of noninitiation of ABX for babies delivered for maternal indications (ie, pregnancy-induced hypertension, intrauterine growth restriction), if clinically behaving like their GA. Excluded premature infants younger than 34 weeks GA on more than minimal respiratory support who will require ATB initiation and continuation until blood cultures are negative.

4. Changed from “Counting doses” to “Complete X days of treatment” to avoid administering extra doses of ABX when dose or medication changes.

5. Encouraged discontinuation of ABX before 48 hours for early-onset sepsis. Every 12 hour Ampicillin (last dose at 36 hours) and every 24 hour Gentamicin (last dose at 24 hours) will protect baby through 48 hours.

6. Encouraged ATB discontinuation when blood culture negative at 36−48 hours for late-onset sepsis.

7. Created standardized pre- and postoperative order set in the electronic health record for surgical conditions.

8. Recommended 5-day ATB treatment course for diagnosed pneumonia.

9. Created neonatal antibiogram to assist in making educated empiric ATB choices.

10. Created late-onset sepsis tool and code sepsis checklist27 to assist in making multidisciplinary decisions regarding need for sepsis workups and ABX.

ABX, antibiotics; APP, advanced practice practitioner; ATB, antibiotic; GA, gestational age.