title: Antibiotic Stewardship Challenges in a Referral Neonatal Intensive Care Unit.
abstract: 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.
authors.affiliation: Department of Pharmacy, Children's Medical Center Dallas, Dallas, Texas.
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Shipp
authors.affiliation: Department of Pharmacy, Children's Medical Center Dallas, Dallas, Texas.
authors.forename: Tracy
authors.initials: T
authors.lastname: Chiang
authors.affiliation: Department of Pharmacy, Children's Medical Center Dallas, Dallas, Texas.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Karasick
authors.affiliation: Department of Pharmacy, Children's Medical Center Dallas, Dallas, Texas.
authors.forename: Kayla
authors.initials: K
authors.lastname: Quick
authors.affiliation: Department of Pharmacy, Children's Medical Center Dallas, Dallas, Texas.
authors.forename: Sean T
authors.initials: ST
authors.lastname: Nguyen
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Cantey
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D000071074:Neonatal Sepsis / Q000188:drug therapy*; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D062606:Tertiary Care Centers; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents