Bhavsar Sejal M, Casella Erica B, Kim Maureen, Lake Patrick, Malik Sabrina, Philips Kaitlyn, Shah Pooja, Shyamalan Shevaitha T, Hagmann Stefan
From the Division of Pediatric Infectious Diseases, Joseph M. Sanzari Children's Hospital, Hackensack, N.J.
Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, N.J.
Pediatr Qual Saf. 2025 May 5;10(3):e810. doi: 10.1097/pq9.0000000000000810. eCollection 2025 May-Jun.
Late-onset sepsis (LOS) is a common cause of neonatal morbidity and mortality. Professional organizations recommend avoiding empiric vancomycin use in neonates without risk factors for methicillin-resistant infection. We aimed to reduce the mean vancomycin antibiotic utilization rate (AUR) by 30% for 12 months in our neonatal intensive care unit (NICU).
We included neonates admitted to our level-3 NICU from March 15, 2023, to February 29, 2024, with suspected LOS in the intervention period. A multidisciplinary team used the Model for Improvement. Interventions tested using plan-do-study-act cycles included provider education, clinical practice guideline (CPG) implementation, and prospective audit with feedback (PAF). The outcome measure was the mean vancomycin AUR measured in days of therapy per 1,000 patients days, plotted monthly and analyzed for special cause variation. The process measure was CPG adherence. We tracked balancing measures related to morbidity and mortality.
During the intervention period, 50 neonates underwent LOS evaluations. The mean vancomycin AUR decreased by 37.1%, from 27 to 17 days of therapy per 1,000 patient days, and was sustained postintervention. CPG adherence was 96%. Three neonates required changing from oxacillin to vancomycin for coagulase-negative staphylococci bacteremia (n = 2) and urinary tract infection (n = 1). There were no drug-related morbidity or sepsis-related mortality events.
This quality improvement project allowed a safe, rapid and sustained reduction of NICU-wide vancomycin use. Provider education, CPG implementation, and PAF were critical to optimizing empiric antibiotic management.
迟发性败血症（LOS）是新生儿发病和死亡的常见原因。专业组织建议，对于没有耐甲氧西林感染风险因素的新生儿，避免经验性使用万古霉素。我们的目标是在新生儿重症监护病房（NICU）将万古霉素抗生素使用率（AUR）的平均值在12个月内降低30%。
我们纳入了2023年3月15日至2024年2月29日期间入住我们三级NICU且在干预期疑似患有LOS的新生儿。一个多学科团队采用了改进模型。使用计划-实施-研究-改进循环进行测试的干预措施包括提供者教育、临床实践指南（CPG）的实施以及带反馈的前瞻性审核（PAF）。结果指标是每1000个患者日中以治疗天数衡量的万古霉素平均AUR，每月绘制图表并分析特殊原因变异。过程指标是CPG依从性。我们跟踪了与发病率和死亡率相关的平衡指标。
在干预期，50名新生儿接受了LOS评估。万古霉素平均AUR下降了37.1%，从每1000个患者日27天的治疗天数降至17天，且在干预后得以维持。CPG依从率为96%。三名新生儿因凝固酶阴性葡萄球菌血症（n = 2）和尿路感染（n = 1）需要从苯唑西林改为万古霉素。没有药物相关的发病事件或败血症相关的死亡事件。
这个质量改进项目实现了全NICU范围内万古霉素使用的安全、快速且持续的减少。提供者教育、CPG实施和PAF对于优化经验性抗生素管理至关重要。
