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Antimicrobial Stewardship in a Tertiary Neonatal Intensive Care Unit with Limited Resources

Received: 25 June 2020     Accepted: 16 July 2020     Published: 28 July 2020
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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.

Published in American Journal of Pediatrics (Volume 6, Issue 3)
DOI 10.11648/j.ajp.20200603.30
Page(s) 295-299
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Antimicrobial Stewardship, NICU, DOT, Early Onset Sepsis, Late Onset Sepsis, NEC, Antibiotics

References
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Cite This Article
  • APA Style

    Fouzia Naeem, Ashley Thomas, Brenik Kuzmic, Indira Chandrasekar. (2020). Antimicrobial Stewardship in a Tertiary Neonatal Intensive Care Unit with Limited Resources. American Journal of Pediatrics, 6(3), 295-299. https://doi.org/10.11648/j.ajp.20200603.30

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    ACS Style

    Fouzia Naeem; Ashley Thomas; Brenik Kuzmic; Indira Chandrasekar. Antimicrobial Stewardship in a Tertiary Neonatal Intensive Care Unit with Limited Resources. Am. J. Pediatr. 2020, 6(3), 295-299. doi: 10.11648/j.ajp.20200603.30

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    AMA Style

    Fouzia Naeem, Ashley Thomas, Brenik Kuzmic, Indira Chandrasekar. Antimicrobial Stewardship in a Tertiary Neonatal Intensive Care Unit with Limited Resources. Am J Pediatr. 2020;6(3):295-299. doi: 10.11648/j.ajp.20200603.30

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  • @article{10.11648/j.ajp.20200603.30,
      author = {Fouzia Naeem and Ashley Thomas and Brenik Kuzmic and Indira Chandrasekar},
      title = {Antimicrobial Stewardship in a Tertiary Neonatal Intensive Care Unit with Limited Resources},
      journal = {American Journal of Pediatrics},
      volume = {6},
      number = {3},
      pages = {295-299},
      doi = {10.11648/j.ajp.20200603.30},
      url = {https://doi.org/10.11648/j.ajp.20200603.30},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20200603.30},
      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 P 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.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - Antimicrobial Stewardship in a Tertiary Neonatal Intensive Care Unit with Limited Resources
    AU  - Fouzia Naeem
    AU  - Ashley Thomas
    AU  - Brenik Kuzmic
    AU  - Indira Chandrasekar
    Y1  - 2020/07/28
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ajp.20200603.30
    DO  - 10.11648/j.ajp.20200603.30
    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
    SP  - 295
    EP  - 299
    PB  - Science Publishing Group
    SN  - 2472-0909
    UR  - https://doi.org/10.11648/j.ajp.20200603.30
    AB  - 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 P 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.
    VL  - 6
    IS  - 3
    ER  - 

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Author Information
  • Department of Pediatric Infectious Disease, Valley Children’s Hospital, Madera, the United States

  • Department of Pharmacy, Valley Children’s Hospital, Madera, the United States

  • Department of Pharmacy, Valley Children’s Hospital, Madera, the United States

  • Department of Pediatrics, Stanford University School of Medicine (affiliated), Stanford, the United States

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