Abstract
Objective Previous analyses of neonatal intensive care units (NICU) antimicrobial stewardship
programs have identified key contributors to overall antibiotic use, including prolonged
empiric therapy >48 hours for early-onset sepsis (EOS). However, most were performed
in mixed NICU settings with onsite birthing units, resulting in a high proportion
of inborn patient admissions. The study aimed to describe and analyze the most common
reasons for antimicrobial use in an outborn tertiary care NICU.
Study Design This was a 10-month review of all antimicrobial doses prescribed in a 20-bed level
III NICU. The primary outcome was the total days of therapy (DOT) and length of therapy
(LOT) for each clinical indication. Secondary outcomes included total DOT for each
antimicrobial and appropriateness of antimicrobial courses.
Results Of 235 antibiotic courses and 1,899 DOT (519 DOT/1,000 patient days) prescribed in
173 infants during the study period, the most common indications were suspected EOS,
followed by prophylaxis. Among the 85 DOT/1,000 patient days (PD; 38 courses) prescribed
for prophylaxis, 52.5 DOT/1,000 PD (25 courses; 62%) were for surgical prophylaxis.
Of 17 postoperative antibiotic courses, 15 (88.2%) were deemed to be inappropriate
mostly due to a duration greater than 24 hours postoperatively (n = 13; median LOT = 3 days).
Conclusion Surgical prophylaxis is a common reason for antimicrobial misuse in outborn NICU.
NICU-based prospective audit and feedback between neonatologists and antimicrobial
stewardship teams alone may not be impactful in this setting. Partnerships with neonatologists
and surgeons will be key to achieving the target of less than 24 hours of postoperative
antimicrobials.
Key Points
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Surgical prophylaxis is a common reason for antimicrobial misuse in the NICU.
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Antimicrobial prophylaxis duration of less than 24 hours postoperatively should be
encouraged.
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NICU-based prospective audit and feedback may not be impactful unless surgeons are
involved.
Keywords
antimicrobial stewardship - NICU - surgical prophylaxis
