Effect of Weekly Antibiotic Round on Antibiotic Use in the Neonatal Intensive Care Unit as Antibiotic Stewardship Strategy

Abstract

Background: Antibiotics are commonly used in the neonatal intensive care unit (NICU). The objective was to observe the effect of weekly antibiotic round in NICU (WARN) to the antibiotic use in NICU. Methods: A retrospective observational study was performed. Departmental-level diagnosis categories and the parameters of antibiotic usage in NICU for the period of 2016-2017 (Phase 1) and 2018-2019 (Phase 2) were collected. WARN in NICU was started since January 2018. A time series forecasting was used to predict the quarterly antibiotic use in Phase 2, based on data from Phase 1. The actual antibiotic use of each quarter in Phase 2 was compared with the predicted values. Results: Totally 9297 neonates were included (4743 in Phase 1, 4488 in Phase 2). The composition of the disease spectrum between Phase 1 and Phase 2 was not different (P > 0.05). In Phase 1 and Phase 2, the overall antibiotic rate was 94.4 and 74.2%, the average accumulative defined daily dose per month was 199.00 ± 55.77 and 66.80 ± 45.64, the median antibiotic use density per month was 10.31 (9.00-13.27) and 2.48 (1.92-4.66), the median accumulative defined daily dose per case per month was 0.10 (0.09-0.13) and 0.03 (0.02-0.47), the number of patients who received any kind of antibiotic per 1000 hospital days per month was 103.45 (99.30-107.48) and 78.66 (74.62-82.77), rate of culture investigation before antibiotics was 64 to 92%, respectively, and all were better than the predicted values (P < 0.01). Conclusion: The implementation of periodical antibiotic rounds was effective in reducing the antibiotics use in the NICU.

Keywords: antibiotic stewardship; antibiotic use; children's hospital; hospitalization; neonatal intensive care unit.

Figure 1

The antibiotics consumptions after time series forecasting. The blue curve was the observed values curve from January 2016 to December 2019, the yellow curve was the predicted time-series values curve based on the data from January 2016 to December 2017, and the dots curves were the upper/lower level of 95% confidence interval of the predicted curve. The orange vertical line indicated the starting time of the weekly antibiotic round. The observed values curve for antibiotics use rates (A), number of patients who received any kind of antibiotic per 1,000 hospital days (B), antibiotic use density (C), had an overall decreasing trend from January 2016 to December 2019, but were progressively lower than the predicted values curve from January 2018 to December 2019 (P < 0.01). The pediatric conserve antibiotics rates (D) and number of patients who received pediatric conserve antibiotics per 1000 hospital days (E) were not significantly different between the observed values curve and predicted time-series values curve (P > 0.05). The observed values curve for rate of culture investigation before antibiotics (F) had an overall increasing trend from January 2016 to December 2019, but were progressively higher than the predicted values curve from January 2018 to December 2019 (P < 0.01).