Category: Professional Posters
Purpose: To reduce unnecessary and inadequate antibiotic usage by implementing an antimicrobial stewardship program in level IV NICU at the American University of Beirut Medical Center, an academic tertiary referral medical center in Beirut, Lebanon.
Methods: A multidisciplinary team consisting of a neonatologist, an ID physician and a pediatric clinical pharmacist was formed. Unit specific algorithms to guide antibiotic prescribing in neonatal early onset sepsis and late onset sepsis were developed with focus on medical team education, daily and weekly prescriber audits and feedback. An interrupted time-series analysis to evaluate the effect of our ASP was performed. Data on neonatal Antibiotic Usage Rate (AUR) was measured using Length of Therapy (LOT) per 1000 patient days, defined as the number of calendar days during which a patient was on antibiotics regardless of the number of antibiotics used. Data presented in this abstract includes pre-implementation (calendar year 2015) and post-implementation (April 2017 through October 2018) phases obtained through retrospective chart review of patients admitted to our NICU.
Results: Antibiotic use among all neonates admitted to NICU decreased by 43% (67% to 38%) post implementation. Similarly, neonates requiring more than one course of antibiotic decreased from 36% to 27%. AUR decreased by 42% from 400.8 per 1000 patient days to 202 per 1000 patient days after 1 year of ASP implementation. Subsequently, average length of stay decreased by 29% from 27.37 days in the baseline data to 19.43 days post implementation. The Antibiotic Stewardship program has resulted in 85% reduction in empirical antibiotic treatment.
Conclusion: The ASP has been successful in optimizing antibiotic prescribing among neonates. The results have shown improvement in patient care as reflected by shorter antibiotic courses and length of stay without increase in morbidity and mortality. Further refinement of the ASP is underway through optimizing the antimicrobial utilization measures and implementing automatic stop orders interventions provided by our new electronic health record. Other improvement projects include the development of national guidelines adapted to our resistance patterns and prevalent organisms and starting a collaboration network with others NICUs at the national level.