Prospective Surveillance of Antibiotic Use in the Neonatal Intensive Care Unit

Results From the SCOUT Study

Joseph B. Cantey, MD; Phillip S. Wozniak; Pablo J. Sánchez, MD

Disclosures

Pediatr Infect Dis J. 2015;34(3):267-272. 

In This Article

Abstract and Introduction

Abstract

Background Prolonged or unnecessary antibiotic use is associated with adverse outcomes in neonates. Our objectives were to quantify all antibiotic use in a Level-III neonatal intensive care unit and to identify scenarios where their use could be reduced.

Methods Surveillance and evaluation of all antibiotic use provided to every infant admitted to a Level-III neonatal intensive care unit from 10/3/11 to 11/30/12 was performed. Types of antibiotics, reasons for their initiation, discontinuation and duration, as well as clinical, laboratory and outcome data were recorded. Antibiotic use was quantified by days of therapy (DOT) per 1000 patient-days (PD).

Results A total of 1607 infants were included. The total antibiotic use was 9165 DOT (343.2 DOT/1000 PD; 5.7 DOT/infant). Seventy-two percent of infants received 1 (43%) or more (29%) courses of antibiotics. Gentamicin (46%), ampicillin (39%) and oxacillin (8%) were the most frequently used agents. Ninety-four percent of antibiotic use (323 DOT/1000 PD) was empiric therapy for suspected infection. Sixty-three percent (216.2 DOT/1000 PD) was discontinued at approximately 48 hours when cultures were sterile (68% >48 hours, 32% ≤48 hours). Twenty-six percent of all antibiotic use (89.4 DOT/1000 PD) was therapy for ≥5 days despite sterile cultures; pneumonia (16%) and "culture-negative" sepsis (8%) were the major contributors. Five percent (17.4 DOT/1000 PD) of antibiotic use was for culture-proven sepsis, 5% (16.6 DOT/1000 PD) was penicillin prophylaxis for group B Streptococcus and 1% (3.5 DOT/1000 PD) was preprocedural prophylaxis.

Conclusions Narrow-spectrum therapy accounted for >92% of antibiotic use and would not be monitored by most stewardship programs. Only 5% of antibiotic usage was due to culture-proven infection. Pneumonia and "culture-negative" sepsis were frequent reasons for prolonged therapy; further study of these conditions may allow reduction in treatment duration.

Introduction

Antibiotics are the most prescribed medications in neonatal intensive care units (NICUs) in the United States.[1,2] When used appropriately, antibiotics are life-saving, but their overuse in NICUs has been associated with an increased risk for infection due to multidrug resistant organisms, invasive candidiasis, necrotizing enterocolitis, late-onset sepsis and even death.[3–10] For this reason, pediatric infectious disease specialists and neonatologists have urged development of antibiotic stewardship programs aimed at reducing overall antibiotic consumption and curtailing their unnecessary use in NICUs.[11] Before such programs can be designed and implemented successfully, prospective surveillance is needed to inform how and why antibiotics are being used locally.[12] Thus, antibiotic stewardship in the NICU will require a thorough understanding of the clinical decisions driving their use.[13,14] Currently, data regarding why and how antibiotics are used in the NICU is limited to retrospective observational data suggesting that inappropriate or unnecessary antibiotic use may be common.[15] Therefore, the objective of the SCOUT (Surveillance and Correction of Unnecessary Antibiotic Therapy) study was to inform future antibiotic stewardship strategies in a Level-III NICU by (1) performing surveillance and evaluation of all antibiotic use during a 14-month period, (2) determining areas where antibiotic use could be reduced safely and then (3) implementing those interventions and monitoring for safety. The results of the initial surveillance are presented here.

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