Antimicrobial Stewardship in the Neonatal Unit: A Quality Improvement Initiative

BACKGROUND: Antimicrobial stewardship is an important component of modern medical practice. Audit and surveillance of antibiotic use with feedback to prescribing clinicains is reccomended as a high-impact core stewardship intervention. The aim of this study was to assess and reduce unnecessary antimicrobial use in a neonatal unit. METHODS: A prospective audit was performed to systematically assess compliance of antimicrobial prescribing with local antimicrobial guidelines in September 2016. Following this, educational interventions were applied to improve compliance with the guideline and electronic prescribing was introduced to the neonatal unit. There were two further re-audit periods in December 2016 and March 2017. The primary outcome was a reduction in days of antibiotic therapy per 1,000 patient days (DOT/1,000 patient days). Secondary outcomes were a reduction in prolonged antibiotic courses and improved compliance with the sepsis evaluation guideline. RESULTS: There were 312 neonatal admissions throughout the study. The number of admissions per day did not significantly change from the baseline to intervention period and the groups were comparable for gestation, birth weight and admission diagnosis. There was a significant overall reduction in the primary outcome of DOT/1,000 patient days from 572 to 417 DOT from September to March (P < 0.0001). This represents a 27% reduction in total antibiotic use. Prolonged antibiotic treatment >36 hours in negative PSWU cases were reduced from 82 DOT to 7.5 DOT (P = 0.0004). Similarly treatment courses >5 days for culture negative sepsis were reduced from 46.5 DOT to 7 DOT (P = 0.0009). Compliance with the neonatal sepsis evaluation guideline also improved with a 35% reduction in evaluations for indications not recognized in the guideline. CONCLUSION: Anti-microbial stewardship plays an important role in the neonatal unit in ensuring that the appropriate drug, dose, route and duration of therapy are employed to ensure adequate treatment while minimizing the risks of unnecessary antibiotic use. Monitoring antibiotic prescribing data, as in this audit, can provide useful insights into the trends of antibiotic use and also inform clinicians of potential areas where antibiotic use may be safely reduced. DISCLOSURES: All authors: No reported disclosures.