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Pediatrics. 2019 Nov 1. pii: e20190589. doi: 10.1542/peds.2019-0589. [Epub ahead of print]

A Collaborative Multicenter QI Initiative To Improve Antibiotic Stewardship in Newborns.

Author information

1
Department of Pediatrics, Oregon Health & Science University, Portland, Oregon; dukhovny@ohsu.edu.
2
Vermont Oxford Network, Burlington, Vermont.
3
Children's Hospital at Darmouth-Hitchcock and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
4
Department of Pediatrics, The Robert Larner, MD, College of Medicine, and.
5
Department of Mathematics and Statistics, University of Vermont, Burlington, Vermont.
6
Beth Israel Deaconess Medical Center, Boston, Massachusetts.
7
Harvard Medical School, Harvard University, Boston, Massachusetts.
8
Centers for Disease Control and Prevention, Atlanta, Georgia.
9
Institute for Healthcare Improvement, Boston, Massachusetts.
10
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.
11
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Abstract

OBJECTIVES:

To determine if NICU teams participating in a multicenter quality improvement (QI) collaborative achieve increased compliance with the Centers for Disease Control and Prevention (CDC) core elements for antibiotic stewardship and demonstrate reductions in antibiotic use (AU) among newborns.

METHODS:

From January 2016 to December 2017, multidisciplinary teams from 146 NICUs participated in Choosing Antibiotics Wisely, an Internet-based national QI collaborative conducted by the Vermont Oxford Network consisting of interactive Web sessions, a series of 4 point-prevalence audits, and expert coaching designed to help teams test and implement the CDC core elements of antibiotic stewardship. The audits assessed unit-level adherence to the CDC core elements and collected patient-level data about AU. The AU rate was defined as the percentage of infants in the NICU receiving 1 or more antibiotics on the day of the audit.

RESULTS:

The percentage of NICUs implementing the CDC core elements increased in each of the 7 domains (leadership: 15.4%-68.8%; accountability: 54.5%-95%; drug expertise: 61.5%-85.1%; actions: 21.7%-72.3%; tracking: 14.7%-78%; reporting: 6.3%-17.7%; education: 32.9%-87.2%; P < .005 for all measures). The median AU rate decreased from 16.7% to 12.1% (P for trend < .0013), a 34% relative risk reduction.

CONCLUSIONS:

NICU teams participating in this QI collaborative increased adherence to the CDC core elements of antibiotic stewardship and achieved significant reductions in AU.

PMID:
31676682
DOI:
10.1542/peds.2019-0589

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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