Reducing Antibiotic Exposure in Suspected Neonatal Sepsis.
Prolonged antibiotic therapy is associated with antimicrobial resistance and increased mortality in preterm infants. We evaluated the impact of an automatic stop order (ASO) and C-reactive protein (CRP) on the duration of antibiotics and level of intervention in infants screened for early-onset sepsis who had negative cultures. We introduced an ASO for low-risk infants, then, consequently, for all infants treated for suspected sepsis. We subsequently introduced a single CRP measurement at 36 hours. Between 2011 and 2014, 4 time periods were studied, at baseline and after each intervention. The proportion of infants receiving ≤48 hours of antibiotics increased from 19% to 72.5% ( P < .0001), whereas that of infants receiving avoidable doses (>48 hours and <5 days) fell from 50% to 0.8% ( P < .0001). The use of an ASO decreased the proportion receiving avoidable doses from 26/92 (28.3%) to 9/293 (3.1%); P < .0001. There was a reduction in lumbar punctures performed, from 35% to 20%; P = .015.
1 The University of Glasgow, Scotland, UK.
Christopher Henry
CH
Grant
2 The University of Edinburgh, Scotland, UK.
Andrew
A
Arnott
2 The University of Edinburgh, Scotland, UK.
Tim
T
Brook
2 The University of Edinburgh, Scotland, UK.
Alice
A
Horne
2 The University of Edinburgh, Scotland, UK.
William
W
Hurst
2 The University of Edinburgh, Scotland, UK.
Sarah
S
Kelly
2 The University of Edinburgh, Scotland, UK.
Christina
C
Lang
2 The University of Edinburgh, Scotland, UK.
Madeleine
M
Payne
2 The University of Edinburgh, Scotland, UK.
Hannah
H
Pert
3 South-East of Scotland Deanery, Edinburgh, Scotland, UK.
Sarah
S
Sparrow
3 South-East of Scotland Deanery, Edinburgh, Scotland, UK.
Pakaye Anne
PA
Dokubo
3 South-East of Scotland Deanery, Edinburgh, Scotland, UK.
Natalie
N
Bee
3 South-East of Scotland Deanery, Edinburgh, Scotland, UK.
Ruth
R
Gibbs
4 Royal Infirmary of Edinburgh, Scotland, UK.
Julie-Clare
JC
Becher
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D000071074:Neonatal Sepsis / Q000097:blood / Q000188:drug therapy*; D012189:Retrospective Studies; D013997:Time Factors
D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein
audit; intensive care; neonatology; pharmacology; therapeutics