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Antibiotic stewardship in NICU: De-implementing routine CRP to reduce antibiotic usage in neonates at risk for early-onset sepsis

Journal of Perinatology volume 41, pages 2488–2494 (2021)Cite this article

Subjects

Abstract

Objective

Antibiotic overuse is common in the neonatal intensive care units (NICUs). We evaluated the change in antibiotic utilization rate (AUR) by eliminating routine CRP in the management of early-onset sepsis (EOS).

Methods

Retrospective before-after cohort study in a Level 3B NICU. We made the following practice changes in the management of EOS: (1) stop routine CRP and (2) implement an automatic stop order (ASO) for antibiotics at 48 h. We compared the AUR, defined as any antibiotic use per 1000 patient days before and after practice change.

Result

There was an absolute reduction of 30% in AUR and a decrease in the proportion of neonates receiving antibiotics from the day of life 3–6 in postintervention period. We did not identify any case of partially treated EOS with change in practice.

Conclusion

Elimination of routine CRP and ASO implementation for antibiotics in neonates at risk for EOS decreased AUR.

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Fig. 1: Proportion of infants on antibiotics in pre-intervention and post-intervention period.
Fig. 2: AUR per 1000 patient days (u-chart).

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Authors and Affiliations

  1. Children’s Hospital at Dartmouth, Lebanon, NH, USA

    Neetu Singh & James E. Gray

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  1. Neetu Singh
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  2. James E. Gray
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Contributions

NS conceptualized and designed the study, coordinated and collected data, carried out the analysis, drafted the initial manuscript, and reviewed the manuscript for intellectual content. JG conceptualized and designed the study, collected data, carried out the analysis, and reviewed and revised the manuscript for intellectual content. Both authors approve the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Neetu Singh.

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The authors declare no competing interest.

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Singh, N., Gray, J.E. Antibiotic stewardship in NICU: De-implementing routine CRP to reduce antibiotic usage in neonates at risk for early-onset sepsis. J Perinatol 41, 2488–2494 (2021). https://doi.org/10.1038/s41372-021-01110-w

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