28 NICUs participating in a quality improvement collaborative targeting early-onset sepsis antibiotic use

Kurlen S E Payton; Mihoko V Bennett; Joseph Schulman; William E Benitz; Lisa Stellwagen; Gary L Darmstadt; Jenny Quinn; Alexandria I Kristensen-Cabrera; Courtney C Breault; Michael Bolaris; Linda Lefrak; Jeff Merrill; Paul J Sharek

doi:10.1038/s41372-024-01885-8

28 NICUs participating in a quality improvement collaborative targeting early-onset sepsis antibiotic use

J Perinatol. 2024 Feb 20. doi: 10.1038/s41372-024-01885-8. Online ahead of print.

Authors

Kurlen S E Payton^{1

2}, Mihoko V Bennett^{3

4}, Joseph Schulman⁵, William E Benitz⁴, Lisa Stellwagen⁶, Gary L Darmstadt⁷, Jenny Quinn³, Alexandria I Kristensen-Cabrera³, Courtney C Breault³, Michael Bolaris⁸, Linda Lefrak⁹, Jeff Merrill¹⁰, Paul J Sharek^{3

11

12

13}

Affiliations

¹ Department of Pediatrics, Division of Neonatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. kurlen.payton@cshs.org.
² California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA, USA. kurlen.payton@cshs.org.
³ California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA, USA.
⁴ Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.
⁵ CA Department of Health Care Services, California Children's Services, Sacramento, CA, USA.
⁶ Department of Pediatrics, Division of Academic General Pediatrics, University of California San Diego School of Medicine, San Diego, CA, USA.
⁷ Prematurity Research Center, Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.
⁸ Department of Pediatrics, Division of Infectious Disease, Harbor-University of California Los Angeles Medical Center, Los Angeles, CA, USA.
⁹ California Department of Public Health, Center for Health Care Quality, Health Care Associated Infections Program, Richmond, CA, USA.
¹⁰ Sutter Health Summit Medical Center, Oakland, CA, USA.
¹¹ Department of Pediatrics, Division of Hospitalist Medicine, Stanford University School of Medicine, Stanford, CA, USA.
¹² Department of Pediatrics, Division of Hospitalist Medicine, University of Washington School of Medicine, Seattle, WA, USA.
¹³ Center for Quality and Patient Safety, Seattle Children's Hospital, Seattle, WA, USA.

PMID: 38378826
DOI: 10.1038/s41372-024-01885-8

Abstract

Objective: There is widespread overuse of antibiotics in neonatal intensive care units (NICUs). The objective of this study was to safely reduce antibiotic use in participating NICUs by targeting early-onset sepsis (EOS) management.

Study design: Twenty-eight NICUs participated in this statewide multicenter antibiotic stewardship quality improvement collaborative. The primary aim was to reduce the total monthly mean antibiotic utilization rate (AUR) by 25% in participant NICUs.

Result: Aggregate AUR was reduced by 15.3% (p < 0.001). There was a wide range in improvement among participant NICUs. There were no increases in EOS rates or nosocomial infection rates related to the intervention.

Conclusion: Participation in this multicenter NICU antibiotic stewardship collaborative targeting EOS was associated with an aggregate reduction in antibiotic use. This study informs efforts aimed at sustaining improvements in NICU AURs.