Oct 29, 2016 - Galit Holzmann-Pazgal, MD, FSHEA1; Amir Khan, MD1; Thomas Northrup, MD1;. Christine Domonoske, PharmD2; Eric Eichenwald, MD1; ...
1928. Antimicrobial Utilization in the Neonatal Intensive Care Unit (NICU): A Pressing Need for Stewardship Galit Holzmann-Pazgal, MD, FSHEA1; Amir Khan, MD1; Thomas Northrup, MD1; Christine Domonoske, PharmD2; Eric Eichenwald, MD1; 1University of Texas Health Sciences Center at Houston, Houston, Texas; 2Children’s Memorial Hermann Hospital, Houston, Texas Session: 225. Antibiotic Stewardship: Pediatrics Saturday, October 29, 2016: 12:30 PM Background. Data demonstrate that antibiotics (abx) are overprescribed in NICUs and abx resistance in NICUs is increasing. Most abx use for late onset sepsis (LOS) evaluations in the NICU is empiric. Reasons for continuation of abx despite negative cultures vary and are not well characterized. Methods. Prospective observational study of antibiotic utilization (ABU) in a 118bed level IV NICU to characterize ABU for LOS evaluations with correlation to
cultures, de-escalation of therapy, associated symptoms and reasons for continuation of abx for culture negative evaluations. ABU and culture data were collected for all infants >3 days old. ABU for LOS was defined as appropriate if there was a culture documented infection or necrotizing enterocolitis (NEC). Blood cultures were considered positive if grew a pathogen or ≥2 cultures were positive for a common skin contaminant. Clinical reasons for initiation and continuation of abx were also described. Results. Over 19 months, there were 500 episodes of abx administration in 283 patients. The most common symptoms prompting evaluations for LOS were temperature >37.2 C (48%), increased respiratory support (38%), abdominal distention (20%) and increased apnea/bradycardia (19%). 57% (285/500) had no positive culture. 51% (144/285) received abx for >2 days and 35% (100/285) for >3 days. 29% (42/144) had NEC. Of the remaining 102 episodes with >2 days of abx and no positive culture or NEC, 22% had documented improvement on abx and 17% had clinician perception of infection. 92% (459/500) of episodes had blood cultures performed and 20% (93/459) were positive. 16 episodes had only 1 blood culture positive for a skin contaminant. Of the 77 remaining episodes with bacteremia, the most common clinical symptoms were temperature >37.2 C (52%), followed by increased respiratory support (35%), abdominal distention or feeding intolerance (27%) and increased apnea/bradycardia (25%). Conclusion. Abx are over utilized in the NICU. Most LOS evaluations are negative and incidence of bacteremia is low. De-escalation of therapy is often complicated by clinical improvement or concern for infection despite negative cultures. Patient symptoms are not reliable indicators of sepsis. Criteria for judicious ABU in the NICU are needed. Disclosures. All authors: No reported disclosures
