Antibiotic guidelines reduce late-onset sepsis in NICU, study finds

Clinicians at Yale University School of Medicine's neonatal intensive care unit in New Haven, Conn., significantly lowered rates of late-onset sepsis by enacting an antibiotic stewardship program, according to a study published in Infection Control & Hospital Epidemiology.

A multidisciplinary team of clinicians implemented the unit-specific antibiotic guidelines at the 54-bed, level IV NICU in 2012. The stewardship program aimed to limit the variability in antibiotic prescribing habits among clinicians via a unit-wide educational effort. The unit also used EMRs to keep a daily report of all prescribed antibiotics, which stewardship team members regularly reviewed before offering feedback to clinicians.

Researchers assessed the treatment and health outcomes of all babies treated in the NICU from Jan. 1, 2011, to June 30, 2016. A year before implementing the stewardship program, the NICU recorded an average of 21.2 late-onset sepsis evaluations per 100 days. By 2016, this figure dropped to 8.4 evaluations per 100 days.

Researchers also found clinicians followed the guidelines for 98.75 percent of treatments, and no babies with clinical infections caught a recurrent infection a week after stopping antibiotic treatments.

"So few antimicrobial stewardship programs provide NICU-specific guidelines to cut down on unnecessary prescription practices," said Matthew Bizzarro, MD, medical director of the NICU at Yale-New Haven Children's Hospital and one of the study's authors. "Our use of an EMR-generated daily report, with additional information on the rationale behind each prescription event was somewhat novel and incredibly useful in providing timely feedback and review of prescriber practices."

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