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

Fouzia Naeem; Ashley Thomas; Brenik Kuzmic; Indira Chandrasekar

doi:doi:10.11648/j.ajp.20200603.30

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

Fouzia Naeem, Ashley Thomas, Brenik Kuzmic, Indira Chandrasekar

Published in American Journal of Pediatrics (Volume 6, Issue 3)

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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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

Fouzia Naeem

Department of Pediatric Infectious Disease, Valley Children’s Hospital, Madera, the United States
Ashley Thomas

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

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

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

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Plain Text BibTeX RIS

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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