Improving Antimicrobial Prescribing Practices in the Neonatal ICU

Summary

To determine if 3 randomly assigned bundles of stewardship interventions would reduce overall and inappropriate antimicrobial use in the neonatal intensive care unit (NICU), a pre-post study was performed in 4 NICUs.

Conditions

• Infants in Neonatal Intensive Care Units

Interventions

OTHER

Education Plus (E+)

Education Plus was an intervention developed by the study team based on the Center for Disease Control (CDC) 12 Step Campaign to Prevent Antimicrobial Resistance in Healthcare Settings. The study team provided Education Plus quarterly to prescribers at the three sites (NICU A, B, C) randomized to this intervention. Examples of topics presented were an overview of antimicrobial stewardship principles, epidemiology of healthcare-associated infections (HAIs), prevention of surgical site infections, antimicrobial susceptibility testing, and pharmacokinetic principles. Educational formats included didactic lectures, participation via the audience response system, case vignettes, and panel discussions.

OTHER

Clinical Decision Support

The CDS tool was an intervention developed in consultation with neonatologists and pediatric infectious disease physicians from NICU A and B. Algorithms for empiric and targeted antimicrobial therapy for common pathogens and common clinical scenarios using local antimicrobial susceptibility patterns were developed. The CDS tool also provided additional components to facilitate antimicrobial prescribing, e.g., patient weight, day of life, previous culture results, antimicrobial orders, and selected laboratory results including white blood cell and platelet count, C-reactive protein, creatinine, and therapeutic drug levels. NICUs A and B also received E+

OTHER

Prescriber Audit and Feedback

The prescriber audit and feedback (PAF) intervention was developed by the study team which held focus groups with neonatologists at NICU A (the site randomized to this intervention) to determine the feedback parameters and feedback format as previously described. Neonatologists at NICU A were provided aggregated prescribing data bimonthly that described inappropriate use as described below and prolonged therapy (\>7 days) for culture-negative late onset sepsis. NICU A also received CDS and E+.

Sponsors & Collaborators

• National Institute of Nursing Research (NINR)

  collaborator NIH

• Weill Medical College of Cornell University

  collaborator OTHER

• Children's Hospital of Philadelphia

  collaborator OTHER

• Christiana Care Health Services

  collaborator OTHER

• Columbia University

  lead OTHER

Principal Investigators

• Lisa Saiman, MD, MPH · Columbia University

Study Design

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Model

PARALLEL

Eligibility

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2009-05-01

Primary Completion

2012-04-30

Completion

2012-04-30

Countries

• United States

Study Locations