Abstract
Objective In view of the excessive use of antibiotics in our neonatal intensive care unit (NICU),
we launched a 5-year multidisciplinary quality improvement (QI) initiative in our
NICU in 2018. We had set our aim of decreasing the antibiotic use rate (AUR) from
22 to 17%.
Study Design The QI initiative was conducted in our 53-bed level 3B NICU. We used the core elements
of antibiotic stewardship and focused on improving gaps in knowledge by using updated
standards of care and a multidisciplinary approach. Outcome measures included overall
AUR in NICU. Statistical control chart (P chart) was used to plot the AUR data quarterly.
Results The AUR demonstrated a decline at the onset, and at the end of the initiative the
AUR demonstrated a sustained decline to 13.18%, a 40% decrease from the baseline AUR
of 22%. The changes that were implemented included development of evidence-based guidelines
for babies less than and greater than 35 weeks, daily antibiotic stewardship rounds,
sepsis risk calculator, antibiotic stop orders (48-hour stop, 36-hour soft stop, and
36-hour hard stop), and periodic reviews.
Conclusion Our multidisciplinary approach using all the core elements of an antibiotic stewardship
program significantly decreased AUR in our NICU.
Key Points
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Excessive use of antibiotics may cause harm to the infant's health.
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Indiscriminate use of antibiotics can lead to antibiotic resistance.
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Stewardship programs can significantly decrease AUR in NICUs.
Keywords
antibiotic stewardship program - antibiotic use rate - neonatal early-onset sepsis
- neonatal intensive care unit - sepsis risk calculator
