1. Reducing Unnecessary Antibiotic Usage in the NICU within a Tertiary Healthcare Center
Fred Baker, MD, Michael Garcia, PharmD, Tiffany Transue, BSN, Megan Bell, BSN, Janet Clark, NNP, Sherry
Johnson, NNP, Diane Brace, BSN, AnneMarie West, BSN MBA, Staci Warren, PharmD
Charles.Baker@providence.org
BACKGROUND
AIM
RESULTS
CONCLUSION
REFERENCES
1. Escobar GJ, Puopolo KM, Wi S, et al. Stratification of risk of early-onset sepsis
in newborns ≥34 weeks’ gestation. Pediatrics 2014:133;30-36.
2. Polin RA. Management of neonates with suspected or proven early-onset
bacterial sepsis. Pediatrics 2012;129:1006-15.
3. Puopolo KM, Draper D, Wi S, et al. Estimating the probability of neonatal
early-onset infection on the basis of maternal risk factors. Pediatrics
2011;128:e1155-62.
4. Verani JR, McGee L, Schrag SJ. Prevention of perinatal group b streptococcal
disease: revised guidelines from CDC 2010. MMWR Recomm Rep
2010;59(RR-10):1–36.
5. Warren S, Garcia M, Hankins C. Neonatal Early-Onset Sepsis (EOS) Risk
Calculator Validation and Assessment of Current Guideline Adherence within
Two Tertiary Healthcare Centers. Poster Presentation. Providence Academic
Achievement Day 2016.
• Neonatal early onset sepsis (EOS), defined as sepsis
occurring within 72 hours of life, is a rare but serious
infection that requires prompt intervention
• A retrospective chart review including six months of
data between 2014 and 2015 within our institution’s
NICU and Nursery demonstrated a decrease in
number of antibiotics recommended from 92% using
CDC/AAP guidelines to 34% using the Kaiser EOS
sepsis risk calculator
• Antibiotic usage within our institution’s NICU
averaged 134 antibiotics days/1000 admission days
in 2015 (median 5 antibiotic days/patient)
• To decrease the antibiotic utilization rate in the PPMC
NICU and newborn nursery by 10% by 12/31/16
• Achieve 75% compliance with antibiotic-focused
discussion between the provider and parents of
infants on antibiotics
MECHANISMS
• 16 bed Type A NICU in Portland, Oregon, with a
delivery service of ~2800 infants per year
• Drivers for opportunities for change include
organizational commitment, pharmacy monitoring,
antibiotic prescribing policies, communication
METHODS
• Implementation of 36 hour antibiotic hard stops in
well-appearing infants treated for early onset sepsis
(January 2016)
• NICU RN Antimicrobial Stewardship (AMS) Survey
(April 2016)
• Implementation of EOS calculator on all admissions
≥ 34 weeks gestation and < 72 hours of age (July
2016)
• Implementation of antibiotic rounds as part of daily
multidisciplinary rounds (July 2016)
NICU RN Antimicrobial
Stewardship Survey
N=34
How long is our standard
antibiotics course for rule-
out sepsis?
36 hours (53%)
How often is the indication
for antibiotic use in a
patient made clear to you?
Almost always (41%)
How often is the specific
choice of antibiotic therapy
made clear to you?
Almost always (41%)
How often is the duration
of an antibiotic course
made clear to you?
Almost always (44%)
RESULTS
SETTING
MEASURES
• Antibiotic utilization rates (antibiotic days/1000
patient days; median antibiotic days/patient)
• 36 hour antibiotic hard stop compliance
• EOS calculator data & compliance assessment
• NICU AMS rounds auditing
• Hardstop compliance
• AMS rounds audit
• Calculator Compliance
• Antibiotic usage within our institution’s NICU
increased 1% to average 135 antibiotic days/1000
admission days in 2016 (Jan-Aug)
• Median total patient antibiotic days within our
institution’s NICU decreased 20% to 4 antibiotic
days/patient in 2016 (Jan-Aug)
% Hard Stop Compliance
(Early Onset Sepsis)
Hard Stops on EOS
Antibiotic Orders
Sep-Dec
2015
Jan-Aug
2016
36 hours 21% 61%
Any 50% 87%
• EOS calculator data & compliance assessment (in
progress)
• NICU AMS rounds assessment (in progress)
• Implementation of a 36 hour hard stop for antibiotics
being administered to well appearing infants with
negative cultures has led to a decrease in our
median total antibiotic days per patient while our
AUR has slightly increased during 2016
• Compliance in ordering antibiotic hard stops has
improved in 2016 following implementation of 36
hour hard stop policy
• Implementation of the Kaiser EOS sepsis risk
calculator, improving communication between
providers, staff, and families through daily AMS
rounds, and developing a Newborn AMS Team, will
further efforts to minimize unnecessary antibiotic
exposure within our NICU population
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Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16
TotalAntibioticDays
NICU Total Antibiotic Days/1000
NICU Abx Days/1000 Linear (NICU Abx Days/1000)
36 hour stop
EOS Calculator
AMS Rounds
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5
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Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16
TotalAntibioticDays
NICU Total Antibiotic Days Per Patient
Total Abx Days Per Patient Median Abx Days