Implementation of an Automatic Stop Order and Initial Antibiotic Exposure in Very Low Birth Weight Infants.
ObjectiveTo evaluate if an antibiotic automatic stop order (ASO) changed early antibiotic exposure (use in the first 7 days of life) or clinical outcomes in very low birth weight (VLBW) infants.Study DesignWe compared birth characteristics, early antibiotic exposure, morbidity, and mortality data in VLBW infants (with birth weight <= 1500 g) born 2 years before (pre-ASO group,n= 313) to infants born in the 2 years after (post-ASO,n= 361) implementation of an ASO guideline. Early antibiotic exposure was quantified by days of therapy (DOT) and antibiotic use > 48 hours. Secondary outcomes included mortality, early mortality, early onset sepsis (EOS), and necrotizing enterocolitis.ResultsBirth characteristics were similar between the two groups. We observed reduced median antibiotic exposure (pre-ASO: 6.5 DOT vs. Post-ASO: 4 DOT;p< 0.001), and a lower percentage of infants with antibiotic use > 48 hours (63.4 vs. 41.3%;p< 0.001). There were no differences in mortality (12.1 vs 10.2%;p= 0.44), early mortality, or other reported morbidities. EOS accounted for less than 10% of early antibiotic use.ConclusionEarly antibiotic exposure was reduced after the implementation of an ASO without changes in observed outcomes.
Division of Neonatology, Department of Pediatrics, Baylor University Medical Center and Pediatrix Medical Group, Dallas, Texas.
Veeral N
VN
Tolia
Division of Neonatology, Department of Pediatrics, Baylor University Medical Center and Pediatrix Medical Group, Dallas, Texas.
Sujata
S
Desai
Department of Quantitative Sciences, Baylor Scott & White Health Care System, Dallas, Texas.
Huanying
H
Qin
Division of Neonatology, Department of Pediatrics, Baylor University Medical Center and Pediatrix Medical Group, Dallas, Texas.
Polli D
PD
Rayburn
Department of Pharmacy, Baylor Hamilton Heart and Vascular Hospital, Dallas, Texas.
Grace
G
Poon
Division of Neonatology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, and the Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Karna
K
Murthy
Center for Research, Education and Quality, MEDNAX Services-Pediatrix Medical Group, Sunrise, Florida.
Dan L
DL
Ellsbury
Division of Neonatology, Department of Pediatrics, Baylor University Medical Center and Pediatrix Medical Group, Dallas, Texas.
Arpitha
A
Chiruvolu
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000073602:Antimicrobial Stewardship; D002985:Clinical Protocols; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology*; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D015994:Incidence; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D065186:Interrupted Time Series Analysis; D008297:Male; D054238:Perinatal Mortality; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy / Q000453:epidemiology*; D013997:Time Factors
D000900:Anti-Bacterial Agents