Antimicrobial Stewardship in Neonates with Necrotizing Enterocolitis: A Quality Improvement Initiative.
Publication/Presentation Date
10-1-2023
Abstract
BACKGROUND: Antibiotic overutilization in the neonatal intensive care unit (NICU) has many adverse effects, and necrotizing enterocolitis (NEC) is one of the most common indications for antibiotics in premature infants. Evidence for a preferred antibiotic regimen for NEC is lacking. This project aims to reduce piperacillin-tazobactam use and overall antibiotic duration in neonates with NEC through the implementation of an antibiotic stewardship pathway based on the modified Bell stage classification system.
METHODS: A multidisciplinary team consisting of neonatology, pharmacy, infectious disease, and surgery developed an antibiotic protocol for the management of NEC based on Bell stage. Recommendations included 48 h of ampicillin/gentamicin (AG) for stage I, 5-10 days of AG for stage II, the addition of metronidazole for stage IIIA, and 7-14 days of piperacillin-tazobactam (PT) for stage IIIB. We evaluated overall antibiotic and PT exposure, progression to surgical NEC, NEC recurrence, antibiotic resistance, bacteremia/fungemia, and mortality 1 year pre- and post-protocol implementation.
RESULTS: 27 patients pre-intervention and 44 post-intervention were analyzed. Antibiotic exposure was reduced from a median 119.19 to 80.65 days of therapy (DOT) per 1000 patient days (p = 0.11). PT exposure decreased after protocol implementation (median 68.78 vs. 7.97 DOT per 1000 patient days, p = 0.002). There were no significant differences in morbidity or mortality outcomes.
CONCLUSIONS: Antibiotic stewardship strategies can be implemented in the NICU without compromising outcomes in patients with NEC. Bell stage stratification appears to be an effective method for antibiotic selection. Further studies are needed in a larger population to optimize regimens and ensure safety.
TYPE OF STUDY: Retrospective comparative study.
LEVEL OF EVIDENCE: Level III.
Volume
58
Issue
10
First Page
1982
Last Page
1989
ISSN
1531-5037
Published In/Presented At
Pace, D., Mack, S. J., Chan, S., Mumford, S. J., Fuchs, L., Shapiro, C., & Berman, L. (2023). Antimicrobial Stewardship in Neonates with Necrotizing Enterocolitis: A Quality Improvement Initiative. Journal of pediatric surgery, 58(10), 1982–1989. https://doi.org/10.1016/j.jpedsurg.2023.06.009
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
37479571
Department(s)
Administration and Leadership
Document Type
Article