CC BY 4.0 · Am J Perinatol
DOI: 10.1055/a-2158-8422
Original Article

Decreasing Antibiotic Use in a Community Neonatal Intensive Care Unit: A Quality Improvement Initiative

Harjinder P. Singh
1   Division of Neonatology, Pomona Valley Hospital Medical Center, Pomona, California
Susan Wilkinson
1   Division of Neonatology, Pomona Valley Hospital Medical Center, Pomona, California
Shahid Kamran
1   Division of Neonatology, Pomona Valley Hospital Medical Center, Pomona, California
› Author Affiliations
Funding None.


Objective In view of the excessive use of antibiotics in our neonatal intensive care unit (NICU), we launched a 5-year multidisciplinary quality improvement (QI) initiative in our NICU in 2018. We had set our aim of decreasing the antibiotic use rate (AUR) from 22 to 17%.

Study Design The QI initiative was conducted in our 53-bed level 3B NICU. We used the core elements of antibiotic stewardship and focused on improving gaps in knowledge by using updated standards of care and a multidisciplinary approach. Outcome measures included overall AUR in NICU. Statistical control chart (P chart) was used to plot the AUR data quarterly.

Results The AUR demonstrated a decline at the onset, and at the end of the initiative the AUR demonstrated a sustained decline to 13.18%, a 40% decrease from the baseline AUR of 22%. The changes that were implemented included development of evidence-based guidelines for babies less than and greater than 35 weeks, daily antibiotic stewardship rounds, sepsis risk calculator, antibiotic stop orders (48-hour stop, 36-hour soft stop, and 36-hour hard stop), and periodic reviews.

Conclusion Our multidisciplinary approach using all the core elements of an antibiotic stewardship program significantly decreased AUR in our NICU.

Key Points

  • Excessive use of antibiotics may cause harm to the infant's health.

  • Indiscriminate use of antibiotics can lead to antibiotic resistance.

  • Stewardship programs can significantly decrease AUR in NICUs.

Author's Contributions

H.S. conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. S.W. designed the data collection instruments, collected data, carried out the initial analysis, and reviewed and revised the manuscript; S.K. contributed to the interpretation of data, reviewed and revised the manuscript.

Antibiotic Stewardship Program Members

Shahid Kamran, MD, NICU Medical Director; Harjinder P. Singh, MD, Neonatologist; Pankaj N. Mistry. MD, Neonatologist; Wang D. Sun, MD, Neonatologist; Susan Wilkinson, RN, Quality Supervisor; Sherri Landazuri, RN; Daniel Gluckstein, MD, Medical Director Infection Control; Jessica Legge, RN, Infection Prevention Nurse; Chin Cong, Pharm D; Thuy Nguyen, Pharm D; Sara Chan, Pharm D.

Publication History

Received: 04 May 2023

Accepted: 16 August 2023

Accepted Manuscript online:
22 August 2023

Article published online:
25 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

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