Optimize the use of antibiotics in the neonatal intensive care unit: an interrupted time series study

Abstract

Abstract Background: This study aims to monitor and evaluate the use of antibiotics in neonates over a 22-month period. The goal is to inform antibiotic stewardship strategies in level 3 neonatal intensive care units (NICU), identify scenarios where antibiotic use could be reduced, and implement interventions while ensuring safety. Methods: Children admitted to NICU from January 1, 2020, to October 31, 2021, constituted the baseline group, while those admitted from November 1, 2021, to December 31, 2022, formed the intervention group. We employed an interrupted time series to analyze variables including the duration of antibiotic use, length of hospital stay, incidence of hospital-acquired infections, and antibiotic resistance in both groups. Results: The study involved a total of 1678 infants, with 1138 in the baseline period and 540 in the intervention period. Analysis of antibiotic utilization in patients during the baseline period revealed statistically significant differences in factors such as positive maternal GBS colonization, mechanical ventilation, prematurity, asphyxia resuscitation, premature rupture of membranes at term exceeding 24 hours, elevated inflammatory markers exclusively, and amniotic fluid III° contamination. The rate of antibiotic use decreased from 182.2 days per 1000 patient days in the baseline period to 31.6 days per 1000 patient days in the intervention period. Additionally, the duration of hospitalization, occurrences of nosocomial infections, and the percentage of multidrug-resistant bacteria in blood cultures were significantly lower in the baseline period. Conclusion: In cases of suspected EOS in children where clear evidence of infection is lacking, judicious administration of antibiotics is recommended. This is particularly important in situations involving pregnant mothers with positive GBS colonization, preterm delivery, contaminated amniotic fluid, elevated inflammatory markers exclusively, premature rupture of membranes in term infants exceeding 24 hours, resuscitation for asphyxia, and mechanical ventilation. Such careful use of antibiotics may lead to a reduction in the duration of antibiotic treatment, a decrease in the occurrence of nosocomial infections, and a lower prevalence of antibiotic-resistant organisms.