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Effectiveness of a neonatal intensive care unit–specific antimicrobial stewardship program: A ten-year review

Published online by Cambridge University Press:  03 February 2023

Katrina H. Assen ,
Vanessa Paquette ,
Arianne Y. Albert ,
Ginger Shi ,
Jocelyn A. Srigley Open the ORCID record for Jocelyn A. Srigley [Opens in a new window] ,
Horacio Osiovich Open the ORCID record for Horacio Osiovich [Opens in a new window] ,
Ashley D. Roberts  and
Joseph Y. Ting Open the ORCID record for Joseph Y. Ting [Opens in a new window]
Katrina H. Assen
Affiliation:
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
Vanessa Paquette
Affiliation:
Department of Pharmacy, Children’s and Women’s Health Centre of British Columbia, Vancouver, British Columbia, Canada
Arianne Y. Albert
Affiliation:
Women’s Health Research Institute, Vancouver, British Columbia, Canada
Ginger Shi
Affiliation:
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
Jocelyn A. Srigley
Affiliation:
Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Horacio Osiovich
Affiliation:
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
Ashley D. Roberts
Affiliation:
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
Joseph Y. Ting*
Affiliation:
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
*
Author for correspondence: Joseph Y. Ting, E-mail: joseph.ting@ualberta.ca
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Abstract

Objective:

To evaluate the change in consumption of specific antibiotics in a neonatal intensive care unit after the implementation of an antimicrobial stewardship program (ASP).

Design:

Retrospective cohort study between January 1, 2010, and December 31,2019.

Setting:

The neonatal intensive care unit at British Columbia Women’s Hospital (Vancouver Canada), a tertiary-care center.

Patients:

Admitted neonates prescribed antibiotics.

Methods:

We implemented an ASP with an early implementation phase starting in January 2014 (period 2) and a later phase starting in January 2017 (period 3). Patient demographics were collected, including birth weight, gestational age, history of necrotizing enterocolitis (NEC), and surgical operations from existing databases. Interrupted time-series analysis was used, and comparison of antibiotic days of therapy (DOT) averages were conducted across the preimplementation period (period 1), period 2, and period 3 regarding total patients and subgroups.

Results:

We identified 4,512 infants. There was a significant decrease in DOT from 472 (95% confidence interval [CI], 431–517) in period 1 to 405 (95% CI, 367–446) in period 2 to 313 (95% CI, 280–350) in period 3. We detected a significant decrease in the use of ampicillin, aminoglycosides, cloxacillin, and linezolid but not in vancomycin or cefotaxime. Subgroup analyses of infants <1,500 g and those without NEC or surgery showed decreases in the use of cloxacillin, aminoglycosides, and linezolid.

Conclusions:

The implementation of an ASP was associated with a significant decrease in the overall DOT and use of certain antibiotics. This study presents important targets for ongoing ASP work.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 11 , November 2023 , pp. 1718 - 1724
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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