Implementation of an Automatic Stop Order and Initial Antibiotic Exposure in Very Low Birth Weight Infants

To evaluate if an antibiotic automatic stop order (ASO) changed early antibiotic exposure (use in the first 7 days of life) or clinical outcomes in very low birth weight (VLBW) infants. We compared birth characteristics, early antibiotic exposure, morbidity, and mortality data in VLBW infants (with...

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Bibliographic Details
Published in:	American journal of perinatology Vol. 34; no. 2; p. 105
Main Authors:	Tolia, Veeral N, Desai, Sujata, Qin, Huanying, Rayburn, Polli D, Poon, Grace, Murthy, Karna, Ellsbury, Dan L, Chiruvolu, Arpitha
Format:	Journal Article
Language:	English
Published:	United States 01-01-2017
Subjects:	Anti-Bacterial Agents - administration & dosage Anti-Bacterial Agents - therapeutic use Antimicrobial Stewardship Clinical Protocols Enterocolitis, Necrotizing - epidemiology Female Humans Inappropriate Prescribing - prevention & control Incidence Infant, Newborn Infant, Very Low Birth Weight Interrupted Time Series Analysis Male Perinatal Mortality Retrospective Studies Sepsis - drug therapy Sepsis - epidemiology Time Factors
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Summary:	To evaluate if an antibiotic automatic stop order (ASO) changed early antibiotic exposure (use in the first 7 days of life) or clinical outcomes in very low birth weight (VLBW) infants. We compared birth characteristics, early antibiotic exposure, morbidity, and mortality data in VLBW infants (with birth weight <= 1500 g) born 2 years before (pre-ASO group, = 313) to infants born in the 2 years after (post-ASO, = 361) implementation of an ASO guideline. Early antibiotic exposure was quantified by days of therapy (DOT) and antibiotic use > 48 hours. Secondary outcomes included mortality, early mortality, early onset sepsis (EOS), and necrotizing enterocolitis. Birth characteristics were similar between the two groups. We observed reduced median antibiotic exposure (pre-ASO: 6.5 DOT vs. Post-ASO: 4 DOT; < 0.001), and a lower percentage of infants with antibiotic use > 48 hours (63.4 vs. 41.3%; < 0.001). There were no differences in mortality (12.1 vs 10.2%; = 0.44), early mortality, or other reported morbidities. EOS accounted for less than 10% of early antibiotic use. Early antibiotic exposure was reduced after the implementation of an ASO without changes in observed outcomes.
ISSN:	1098-8785
DOI:	10.1055/s-0036-1584522