Amer J Perinatol 2016; 33(05): 518-524
DOI: 10.1055/s-0035-1569990
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Antibiotic Stewardship Challenges in a Referral Neonatal Intensive Care Unit

Kimberly D. Shipp1, Tracy Chiang1, Stephanie Karasick1, Kayla Quick1, Sean T. Nguyen1, Joseph B. Cantey2
  • 1Department of Pharmacy, Children's Medical Center Dallas, Dallas, Texas
  • 2Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
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18. Mai 2015

28. Oktober 2015

18.Dezember 2015 (eFirst)


Background Antibiotic overuse in neonates is associated with adverse outcomes. Data are limited to guide antibiotic stewardship in the neonatal intensive care unit (NICU). Our objective was to identify areas for antibiotic stewardship improvement in a referral NICU.

Methods Retrospective review of antibiotic use administered to infants admitted to a referral NICU compared with an inborn NICU. Antibiotic use was quantified by days of therapy (DOT) per 1,000 patient-days (PD).

Results A total of 78% of referral NICU infants received ≥ 1 course of antibiotics. Infants in the referral NICU received more antibiotic DOT/1,000 PD than in the inborn NICU (558.9 vs. 343.2, p < 0.001), with a higher proportion of broad-spectrum therapy. For infants in the referral NICU, 39% of antibiotic courses were started at the transferring hospital; these were broader in spectrum (28 vs. 20%, p < 0.001) and less likely to be de-escalated or discontinued at 48 to 72 hours (58 vs. 87%, p < 0.001) than courses started after transfer.

Conclusions Compared with the inborn NICU, suspected sepsis in the referral NICU accounted for more antibiotic utilization, which was broad-spectrum and less likely to be de-escalated. Stewardship interventions should include reserving broad-spectrum therapy for infants with risk factors and de-escalating promptly once culture results become available.