Antibiotic guidelines in NICU improve prescription practices for vulnerable infants

"It can be difficult to distinguish infections from other disease symptoms in pre-term infants. Timely interventions for a true infection are critical, but unnecessary exposures to antibiotics can result in antimicrobial resistance, increased risk for serious health conditions, or even death," said Nneka Nzegwu, DO, attending physician in neonatal-perinatal medicine at Brigham and Women's Hospital and an author of the study. "We are encouraged that antimicrobial stewardship in the NICU is gaining focus and attention. Our hope is that our experience assists others on a similar journey."

A multidisciplinary team developed the antibiotic stewardship program consisting of clinical guidelines published to the hospital-based intranet to curtail provider-to-provider variability in prescriptions, as well as a unit-wide educational effort to introduce the principles of stewardship, review guidelines, and present outcomes measures. Using electronic medical records, a daily report of all prescribed antimicrobials was reviewed by stewardship team members, providing timely prescriber oversight and feedback.

Researchers found that as a result of the intervention, healthcare-associated infections decreased, including evaluations for late-onset sepsis, with an average reduction of 2.65 late-onset sepsis evaluations per year and per provider. Overall, in 2011, a year before the stewardship program was implemented, the NICU had an average of 21.2 late-onset sepsis evaluations per 100 days, which decreased to 8.4 evaluations by 2016.

The study found that physicians followed clinical guidelines for prescribing antibiotics for 98.75 percent of treatments performed, and no infants with clinical infections developed a recurrent infection after seven days of discontinuing their antibiotic treatment.

"So few antimicrobial stewardship programs provide NICU-specific guidelines to cut down on unnecessary prescription practices," said Matthew Bizzarro, MD, medical director of the NICU at Yale-New Haven Children's Hospital and an author of the study. "Our use of an electronic medical record-generated daily report, with additional information on the rationale behind each prescription event was somewhat novel and incredibly useful in providing timely feedback and review of prescriber practices."