Reducing intravenous antibiotics in neonates born ≥35 weeks' gestation: A quality improvement study

Erin Grace; Nilarni Jayakumar; Celia Cooper; Chad Andersen; Emily Callander; Judith Gomersall; Alice Rumbold; Amy Keir

doi:10.1111/jpc.16537

Reducing intravenous antibiotics in neonates born ≥35 weeks' gestation: A quality improvement study

J Paediatr Child Health. 2024 Apr-May;60(4-5):139-146. doi: 10.1111/jpc.16537. Epub 2024 May 2.

Authors

Erin Grace^{1

2

3

4}, Nilarni Jayakumar^{1

3}, Celia Cooper⁵, Chad Andersen^{1

3}, Emily Callander⁶, Judith Gomersall^{7

8}, Alice Rumbold^{4

7}, Amy Keir^{1

3

4

7}

Affiliations

¹ Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
² Department of Paediatrics, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, Australia.
³ Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
⁴ Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia.
⁵ Department of Infectious Diseases, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
⁶ Monash Centre for Health Research and Implementation, School of Public Health, Monash University, Melbourne, Victoria, Australia.
⁷ Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia.
⁸ School of Public Health, University of Adelaide, Adelaide, South Australia, Australia.

PMID: 38695518
DOI: 10.1111/jpc.16537

Abstract

Aim: To assess the impact of the Early Onset Sepsis (EOS) calculator, implemented as a quality improvement study, to reduce the rate of unnecessary antibiotics in neonates born ≥35 weeks' gestation.

Methods: An audit of routinely collected hospital data from January 2008 to March 2014 (retrospective) and from January 2018 to September 2019 (prospective) determined baseline incidence of EOS intravenous antibiotic use in neonates born ≥35 weeks' gestation in a tertiary level perinatal centre. Plan-do-study-act (PDSA) cycles were applied to implement the EOS calculator. Statistical process control methodology and time series analysis assessments were used to assess the potential impact of the PDSA cycles on the rate of intravenous antibiotics, blood culture collection, EOS, length of stay and health care costs (not adjusted for potential confounders).

Results: In the study population, from January 2008 to March 2014, the baseline incidence of intravenous antibiotic use was 10.49% (2970/28290), whilst only 0.067% (19/28290) neonates had culture proven EOS. From January 2018 to October 2019, prior to implementation of the EOS calculator, 13.3% (1119/8411) neonates were treated with intravenous antibiotic and the use decreased to 8.3% (61/734) post-implementation. The rate of blood culture collection decreased from 14.4% (1211/8411) to 11.9% (87/734). There were no cases of missed EOS. Length of stay decreased from 2.68 to 2.39 days, with an estimated cost saving of $366 per patient per admission.

Conclusion: Implementing the EOS calculator in a tertiary hospital setting reduced invasive investigations for EOS and intravenous antibiotic use among neonates ≥35 weeks' gestation. This can result in reduced length of neonatal hospital stays, and associated health care cost savings and may reduce separation of mother and baby.

Keywords: antimicrobial stewardship; early onset neonatal sepsis; quality improvement.

© 2024 The Authors. Journal of Paediatrics and Child Health published by John Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

MeSH terms

Administration, Intravenous*
Anti-Bacterial Agents* / administration & dosage
Anti-Bacterial Agents* / therapeutic use
Female
Gestational Age
Humans
Infant, Newborn
Length of Stay / statistics & numerical data
Male
Neonatal Sepsis / drug therapy
Prospective Studies
Quality Improvement*
Retrospective Studies