Antibiotic Stewardship

The Time is Now!
Julie M. Oliver NNP-BC
Coastal Carolina Neonatology
Betty H. Cameron
Women and Children’s Hospital

Antibiotic Stewardship: The Time is Now!
What we do (and don’t do) makes a difference!!
Antibiotic overuse and misuse can lead to
• Antibiotic resistance
• Risk of fungal infections and sepsis
• Nosocomial Infections
• Mortality
• Asthma (later in life)

Antibiotic Stewardship: The Time is Now!
• According to a recent study published by Schulman
(2015), there was a 40-fold variation (from 2.4% to
97.1%) in prescribing antibiotics across 127 similar
NICUs with no difference in outcomes!
– 50% of the intermediate units had the highest AUR but
most reported an infection rate of zero
– Highest AUR NICU had a 35% longer LOS than the lowest

Antibiotic Stewardship: The Time is Now!
The CDC initiative provides the structure needed to
build a strong antibiotic stewardship program.
Some of their goals include:
• Increase monitoring of infections, antibiotic use,
and resistance patterns
• Implement best practices for the prevention of
• Establish appropriate prescription, dose and
duration for antibiotics.

Antibiotic Stewardship: The Time is Now!
North Carolina became the national role model for statewide initiatives with the success of PCQNC’s NCLABSI
Choosing antibiotic stewardship for this PCQNC cycle
enables us to collaborate with the CDC and their
experts, VON, and three state initiatives to address
antibiotic use in the neonate.

North Carolina needs to be part of this collaborative!!

Antibiotic Stewardship: The Time is Now!
Successful antibiotic stewardship programs can
provide the following benefits:
• Predefined antibiotic order sets and alerts
• Automated reports of AUR
• Protocols for specific conditions to decreased
variation in practice
• Potential to reverse resistance patterns

Antibiotic Stewardship: The Time is Now!
Potentially Better Practices
1. Initiate culture change that supports more
appropriate use of antibiotics
2. Develop policies to support use of antibiotics in
specific conditions such as sepsis and NEC
3. Engage pharmacy to help monitor use of antibiotics
4. Report antibiotic use and resistance to the NICU
team consistently and transparently

Antibiotic Stewardship: The Time is Now!
To decrease antibiotic use rate in the NICU by
20% percent by end of year 2017

Antibiotic Stewardship: The Time is Now!
Who should be part of this initiative?
Any hospital in North Carolina that provides
neonatal care.
All babies will benefit from being born in a
hospital that is committed to the judicious use
and surveillance of antibiotics.

Antibiotic Stewardship: The Time is Now!
Impact and Balancing Measures

• The impact of this initiative will be long-lasting
and far-reaching
• Increasing parental awareness will have longterm benefits for their family and for society
as a whole
• Potential decreased length of stay
• Potential reduced incidence of NEC (biome)

Antibiotic Stewardship: The Time is Now!
Challenges and Barriers

•Changing long-standing practices:
–“Treat early and often” because of a fear of not
treating a potentially devastating infection
–Continuing antibiotics for 7 days despite a negative

•Standardizing significant variation in practice
•Parental influence to treat

We can make a difference!!

Vote Antibiotic Stewardship for the
next PCQNC Initiative