Reducing intravenous antibiotics in neonates born ≥35 weeks' gestation: A quality improvement study.
antimicrobial stewardship
early onset neonatal sepsis
quality improvement
Journal
Journal of paediatrics and child health
ISSN: 1440-1754
Titre abrégé: J Paediatr Child Health
Pays: Australia
ID NLM: 9005421
Informations de publication
Date de publication:
02 May 2024
02 May 2024
Historique:
revised:
21
09
2023
received:
01
12
2022
accepted:
18
03
2024
medline:
2
5
2024
pubmed:
2
5
2024
entrez:
2
5
2024
Statut:
aheadofprint
Résumé
To assess the impact of the Early Onset Sepsis (EOS) calculator, implemented as a quality improvement study, to reduce the rate of unnecessary antibiotics in neonates born ≥35 weeks' gestation. An audit of routinely collected hospital data from January 2008 to March 2014 (retrospective) and from January 2018 to September 2019 (prospective) determined baseline incidence of EOS intravenous antibiotic use in neonates born ≥35 weeks' gestation in a tertiary level perinatal centre. Plan-do-study-act (PDSA) cycles were applied to implement the EOS calculator. Statistical process control methodology and time series analysis assessments were used to assess the potential impact of the PDSA cycles on the rate of intravenous antibiotics, blood culture collection, EOS, length of stay and health care costs (not adjusted for potential confounders). In the study population, from January 2008 to March 2014, the baseline incidence of intravenous antibiotic use was 10.49% (2970/28290), whilst only 0.067% (19/28290) neonates had culture proven EOS. From January 2018 to October 2019, prior to implementation of the EOS calculator, 13.3% (1119/8411) neonates were treated with intravenous antibiotic and the use decreased to 8.3% (61/734) post-implementation. The rate of blood culture collection decreased from 14.4% (1211/8411) to 11.9% (87/734). There were no cases of missed EOS. Length of stay decreased from 2.68 to 2.39 days, with an estimated cost saving of $366 per patient per admission. Implementing the EOS calculator in a tertiary hospital setting reduced invasive investigations for EOS and intravenous antibiotic use among neonates ≥35 weeks' gestation. This can result in reduced length of neonatal hospital stays, and associated health care cost savings and may reduce separation of mother and baby.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Authors. Journal of Paediatrics and Child Health published by John Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division (The Royal Australasian College of Physicians).
Références
Goodman D, Ogrinc G, Davies L et al. Explanation and elaboration of the SQUIRE (Standards for Quality Improvement Reporting Excellence) Guidelines, V.2.0: Examples of SQUIRE elements in the healthcare improvement literature. BMJ Qual. Saf. 2016; 25: e7.
Kuzniewicz MW, Puopolo KM, Fischer A et al. A quantitative, risk‐based approach to the management of neonatal early‐onset sepsis. JAMA Pediatr. 2017; 171: 365–371.
Australian and New Zealand Neonatal Network. ANZNN 2023 Data Dictionary. Sydney, Australia: ANZNN; 2022.
De SK, Shetty N, Kelsey M. How to use… Blood cultures. Arch. Dis. Child. Educ. Pract. Ed. 2014; 99: 144–151.
Puopolo KM, Benitz WE, Zaoutis TE; Committee on Fetus and Newborn; Committee on Infectious Diseases. Management of neonates born at ≥35 0/7 weeks' gestation with suspected or proven early‐onset bacterial sepsis. Pediatrics 2018; 142: e20182894. https://doi.org/10.1542/peds.2018-2894.
Singh T, Barnes EH, Isaacs D; Australian Study Group for Neonatal Infections. Early‐onset neonatal infections in Australia and New Zealand, 2002–2012. Arch. Dis. Child Fetal Neonatal. Ed. 2019; 104: F248–52. https://doi.org/10.1136/archdischild-2017-314671.
Giannoni E, Dimopoulou V, Klingenberg C et al. Analysis of antibiotic exposure and early‐onset neonatal sepsis in Europe, North America, and Australia. JAMA Netw. Open 2022; 5: e2243691.
Sun W, Svendsen ER, Karmaus WJ, Kuehr J, Forster J. Early‐life antibiotic use is associated with wheezing among children with high atopic risk: A prospective European study. J. Asthma 2015; 52: 647–652.
Bailey LC, Forrest CB, Zhang P, Richards TM, Livshits A, DeRusso PA. Association of antibiotics in infancy with early childhood obesity. JAMA Pediatr. 2014; 168: 1063–1069.
Mendoza‐Palomar N, Balasch‐Carulla M, Gonzalez‐Di Lauro S et al. Escherichia coli early‐onset sepsis: Trends over two decades. Eur. J. Pediatr. 2017; 176: 1227–1234.
Mukhopadhyay S, Eichenwald EC, Puopolo KM. Neonatal early‐onset sepsis evaluations among well‐appearing infants: Projected impact of changes in CDC GBS guidelines. J. Perinatol. 2013; 33: 198–205.
Berardi A, Bedetti L, Spada C, Lucaccioni L, Frymoyer A. Serial clinical observation for management of newborns at risk of early‐onset sepsis. Curr. Opin. Pediatr. 2020; 32: 245–251.
Achten NB, Klingenberg C, Benitz WE et al. Association of use of the neonatal early‐onset sepsis calculator with reduction in antibiotic therapy and safety: A systematic review and meta‐analysis. JAMA Pediatr. 2019; 173: 1032–1040.
Lee SK, Aziz K, Singhal N, Cronin CM. The Evidence‐based Practice for Improving Quality method has greater impact on improvement of outcomes than dissemination of practice change guidelines and quality improvement training in neonatal intensive care units. Paediatr. Child Health 2015; 20: e1–e9.
Centers for Disease Control and Prevention. National Healthcare Safety Network (NHSN). CDC Master Organisms List; 2019. Available at: www.cdc.gov/nhsn/XLS/master-organism-Com-Commensals-Lists.xlsx.
Allen E, Cavallaro A, Keir AK. A quality improvement initiative to reduce blood culture contamination in the neonatal unit. Pediatr. Qual. Saf. 2021; 6: e413.
Benneyan JC, Lloyd RC, Plsek PE. Statistical process control as a tool for research and healthcare improvement. Qual. Saf. Health Care 2003; 12: 458–464.
Chetter TG. Statistical process control part 2: Using statistical process control to measure process improvement in patient flow. Aust. Health Rev. 2009; 33: 412–422.
Provost LP, Murray SK. The Health Care Data Guide: Learning From Data for Improvement. San Francisco: Jossey‐Bass; 2011.
Strunk T, Buchiboyina A, Sharp M, Nathan E, Doherty D, Patole S. Implementation of the Neonatal Sepsis Calculator in an Australian Tertiary Perinatal Centre. Neonatology 2018; 113: 379–382.
Anderson H, Vuillermin P, Jachno K et al. Prevalence and determinants of antibiotic exposure in infants: A population‐derived Australian birth cohort study. J. Paediatr. Child Health 2017; 53: 942–949.
Osowicki J, Gwee A, Noronha J et al. Australia‐wide point prevalence survey of antimicrobial prescribing in neonatal units: How much and how good? Pediatr. Infect. Dis. J. 2015; 34: e185–e190.
Meyers JM, Tulloch J, Brown K, Caserta MT, D'Angio CT. A quality improvement initiative to optimize antibiotic use in a level 4 NICU. Pediatrics 2020; 146: 1–9.
Gong CL, Dasgupta‐Tsinikas S, Zangwill KM, Bolaris M, Hay JW. Early onset sepsis calculator‐based management of newborns exposed to maternal intrapartum fever: A cost benefit analysis. J. Perinatol. 2019; 39: 571–580.
Mukhopadhyay S, Lieberman ES, Puopolo KM, Riley LE, Johnson LC. Effect of early‐onset sepsis evaluations on in‐hospital breastfeeding practices among asymptomatic term neonates. Hosp. Pediatr. 2015; 5: 203–210.
Wellbeing SA. Pregnancy Outcome in South Australia 2019. Adelaide: Pregnancy Outcome Unit. (Government of South Australia); 2022.
Wellbeing SA. Pregnancy Outcome in South Australia 2018. Adelaide: Pregnancy Outcome Unit. (Government of South Australia); 2021.