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  • Quality Improvement Article
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Reducing antibiotic utilization rate in preterm infants: a quality improvement initiative

Journal of Perinatology volume 38, pages 421–429 (2018)Cite this article

Subjects

Abstract

Background

Judicious use of antibiotic therapy in preterm infants is necessary as prolonged and unwarranted use of antibiotics have been associated with adverse short-term and long-term outcomes.

Local problem

Our baseline data review revealed overuse and unnecessary prolonged antibiotic exposure among preterm infants despite a low suspicion for sepsis.

Methods and interventions

The baseline overall AUR was calculated retrospectively from our pharmacy database for a period of 4 months prior to the quality improvement (QI) initiative (pre-QI phase). The principal QI intervention included the development and implementation of guidance algorithms for evaluation and management of suspected sepsis incorporating key QI measures, such as an emphasis on early discontinuation of antibiotics by 36 h if blood culture remained negative and the introduction of multiplex polymerase chain reaction assay for early identification of causative organisms. This QI initiative was implemented through multiple Plan-Do-Study-Act cycles, starting in February 2016 (QI phase), with an objective to achieve a 10% reduction in the baseline overall AUR by December 2016, in preterm infants with gestational ages between 250/7 and 336/7 weeks. Data for the QI phase of the study were collected prospectively.

Result

The overall AUR (outcome measure) decreased from 154.8 to 138.4 days of treatment per 1000 hospital days (10.6% decrease, p < 0.05) over the 11-month period. However, the overall rate of adherence to guidance algorithm (process measure) remained below the target goal of 90%.

Conclusion

This multiphase QI initiative was able to reduce the overall AUR at our NICU. The beneficial impact of this decrease in AUR in preterm infants remains to be determined.

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Author notes

    Authors and Affiliations

    1. Department of Pediatrics, Children’s and Women’s Hospital, University of South Alabama, Mobile, AL, USA

      Ramachandra Bhat, Haidee Custodio, Richard Whitehurst, Rashmi Gulati, Om Prakash Jha, Jayalakshmi Bhat, Benjamin Estrada, Fabien Eyal & Michael Zayek

    2. Nursing Division, Children’s and Women’s Hospital, University of South Alabama, Mobile, AL, USA

      Cathy McCurley & Amy Hill

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    1. Ramachandra Bhat
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    Correspondence to Ramachandra Bhat.

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    The authors declare that they have no conflict of interest.

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    Ramachandra Bhat and Haidee Custodio contributed equally to this work.

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    Bhat, R., Custodio, H., McCurley, C. et al. Reducing antibiotic utilization rate in preterm infants: a quality improvement initiative. J Perinatol 38, 421–429 (2018). https://doi.org/10.1038/s41372-018-0041-y

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