Volume 6, Issue 3, September 2020, Page: 295-299
Antimicrobial Stewardship in a Tertiary Neonatal Intensive Care Unit with Limited Resources
Fouzia Naeem, Department of Pediatric Infectious Disease, Valley Children’s Hospital, Madera, the United States; Department of Pediatrics, Stanford University School of Medicine (affiliated), Stanford, the United States
Ashley Thomas, Department of Pharmacy, Valley Children’s Hospital, Madera, the United States
Brenik Kuzmic, Department of Pharmacy, Valley Children’s Hospital, Madera, the United States
Indira Chandrasekar, Department of Pediatrics, Stanford University School of Medicine (affiliated), Stanford, the United States; Department of Neonatal Intensive Care Unit, Valley Children’s Hospital, Madera, the United States
Received: Jun. 25, 2020;       Accepted: Jul. 16, 2020;       Published: Jul. 28, 2020
DOI: 10.11648/j.ajp.20200603.30      View  100      Downloads  33
Abstract
Background: Antimicrobial stewardship programs (ASP) have been recognized nationally as an effective way to combat antimicrobial resistance. Using data from the Pediatric Health Information System (PHIS) database, we noticed high utilization of antimicrobials in our hospital particularly in our tertiary level neonatal intensive care unit (NICU). This prompted focused efforts in the NICU consisting of development of management guidelines and prospective audit with intervention and feedback. Method: Using the PHIS database, we retrospectively measured days of therapy per 1000 patient days (DOT/1000 PD) in the NICU during the pre-implementation, implementation and post-implementation phases to determine the change in antimicrobial utilization. All antimicrobials administered between 01/01/14 to 12/31/19 were included in this review. Secondary outcomes including late-onset sepsis (LOS), necrotizing enterocolitis (NEC), mortality rates and hospital-wide antimicrobial utilization were also evaluated. Comparison of means among groups was performed by analysis of variance (ANOVA). Results: Overall, mean DOT/1000 PD for the NICU decreased 32% from the pre-implementation to the post-implementation phase (656.86 vs 480.81 vs 431.90 DOT/1000 PD, P < 0.01). NICU LOS rates decreased from 2.4% to 1.5%. NEC and mortality rates remained unchanged from 4.2% to 4.9% and 3.4% to 4.4%, respectively. Mean DOT/1000 PD for the entire hospital decreased 22% overall (857.09 vs 739.71 vs 667.76 DOT/1000 PD, P < 0.01). Conclusions: Implementation of a NICU ASP helped reduce antimicrobial utilization in the NICU without increasing morbidity and mortality. Hospitals with limited resources may consider targeted unit-based stewardship to help reduce antimicrobial utilization.
Keywords
Antimicrobial Stewardship, NICU, DOT, Early Onset Sepsis, Late Onset Sepsis, NEC, Antibiotics
To cite this article
Fouzia Naeem, Ashley Thomas, Brenik Kuzmic, Indira Chandrasekar, Antimicrobial Stewardship in a Tertiary Neonatal Intensive Care Unit with Limited Resources, American Journal of Pediatrics. Vol. 6, No. 3, 2020, pp. 295-299. doi: 10.11648/j.ajp.20200603.30
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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