P2C068: Effectiveness and Sustainability of an Antimicrobial Stewardship Program in the Neonatal Intensive Care Unit: a Quality Improvement Project

Purpose/Objectives:

Background:
Antibiotic Stewardship Programs (ASPs) have been utilized in the neonatal intensive care unit (NICU) setting to help improve clinical outcomes and minimize harms by improving antibiotic prescribing practices. However, achieving lasting positive changes and results remains a challenge.


Objectives:
1) To determine the effectiveness and sustainability of ASP after its implementation at Kaiser Permanente-Panorama City (KP-PC) NICU as measured by antimicrobial utilization rate (AUR) and neonatal antibiotic exposure (NAE)
2) To evaluate the impact of ASP on 2 groups of infants: a) premature infants < 35 weeks gestation and b) late preterm and term infants equal or > 35 weeks gestation

Design/Methods:

Design: We participated in a state-wide collaborative aimed at reducing antibiotic utilization by 20% in all participating NICUs. We convened a multidisciplinary team and implemented evidence-based interventions. Data were reported to Life QI website and analyses were conducted to evaluate the effects of our ASP thru Plan-Do-Study-Act cycle.
SETTING: At KP-PC NICU, is a 24-bed level III non-surgical NICU.
PARTICIPANTS: All neonates prescribed antimicrobials and compared outcomes between pre-intervention period (January 2019-December 2022 and compared outcomes between pre-intervention period (January 2019-December 2020) and intervention period (January 2021-December 2022).
INTERVENTIONS: 1. Implementation of treatment algorithm for early onset sepsis for 2 gestational age categories: < 35 weeks and equal or > 35 weeks;
2. Antibiotic hardstop on electronic prescribing at 36 hours; and 3. Antibiotic time-out at 48 hours conducted daily consisted of review of indications, clinical course, laboratory results and plan for length of therapy.
MEASURES: Our primary outcome measures were AUR defined as days of antibiotic therapy per patient days for all antimicrobials and NAE defined as number of newborns exposed to antibiotics over total number of live births.

Results:

Results:
NICU-specific ASP resulted in decrease in antibiotic usage at KP-PC NICU that was sustained over 24-month period since its implementation. The overall AUR decreased by 20% from baseline of 8.1% to 6.4% in the intervention period, meeting the collaborative’s minimum goal of 20%. When evaluated separately according to gestational age categories, a more significant reduction in AUR by 34.2% (p=0.02) from baseline of 15.5% to 10.1% was observed in infants equal or > 35 weeks compared with 17.9%, reflecting a decrease from baseline of 6.1% to 5.1% in premature infants < 35 weeks. NAE decreased by 27% from baseline of 5.6% to 4.1% (p = 0.006) in the intervention period.

Conclusion/Discussion: Key objectives were achieved and a sustainable model for ASP was established at KP-PC NICU. Fundamental to our success were employment of interdisciplinary approach to ensure standardization of antibiotic use, staff education, monitoring and prospective review of antibiotic consumption and providing regular feedback to all ASP team members.