769 - Implementation of Antibiotic Stewardship Program in Kaiser Permanente Southern California Neonatal Intensive Care Units: 3-Year Regional Quality Improvement Project

Publication Number: 1745.769

Maria Fe Villosis, Kaiser Permanente Bernard J. Tyson School of Medicine; Southern California Permanente Medical Group (SCPMG), Panorama City, CA, United States; Ma. Teresa Ambat, Kaiser Permanente Bernard J. Tyson School of Medicine, Panorama City, CA, United States; Rosa V. Chen, Kaiser Foundation - Fontana, Fontana, CA, United States; Edgar Chernin, Kaiser Permanente Riverside Medical Center, Riverside, CA, United States; Hannaise Cruz, SCPMG, Los Angeles, CA, United States; Stephanie Dekom, Kaiser Permanente West Los Angeles, Los Angeles, CA, United States; Bisrat Gebrekristos, Kaiser Permanente Pediatric Care Center, Irvine, CA, United States; Nicholas Lynch, kaiser foundation hospital - Baldwin Park Medical Center, Baldwin Park, CA, United States; Arash Moghimi, Kaiser Permanente Pediatric Care Center, los angeles, CA, United States; Rohit Passi, Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, United States; Pedro F.. Paz, Kaiser Foundation Hospital- San Marcos, San Marcos, CA, United States; Kambiz Kevin. Rezaie, Kaiser Permanente - Panorama City Medical Center, Panorama City, CA, United States; Carl E. Shangle, Kaiser Permanente San Diego, San Diego, CA, United States; Linda J. Tesoriero, Kaiser Permanente Bernard J. Tyson School of Medicine, Orange, CA, United States; Huy Truong, Kaiser Permanente Bernard J. Tyson School of Medicine, Fontana, CA, United States; James Washington, scpmg, Riverside, CA, United States; Quinn Hong, SCPMG, West Covina, CA, United States; Marielle Nguyen, Kaiser Permanente-Southern California, Anaheim, CA, United States

Background: Antibiotic stewardship programs (ASPs) are critically necessary for optimizing responsible antibiotic use and combating antimicrobial resistance.
The implementation of ASPs through quality improvement (QI) initiatives can enhance antibiotic prescribing practices, minimize unnecessary antibiotic exposure and serious side effects, and improve neonatal outcomes.

Objective: 1) To safely reduce antibiotic use for early onset sepsis (EOS) evaluation to a rate of 15% or a decrease of the rate by 2% among infants > 35 weeks gestation admitted at Kaiser Foundation Hospitals - Southern California (KFH-SCAL) NICUs by implementing a 36-hr automatic stop order (ASO) for antibiotics. 2) To evaluate the effect of 36-hr ASO on other adverse outcomes.

Design/Methods: This was a QI initiative at KFH-SCAL involving its 15 NICUs focusing on implementation of 36-hr ASO as key component of the ASP intended to safely reduce antibiotic utilization rate (AUR). AUR defined as all infants > 35 weeks gestation who are admitted to NICU within 3 days of birth and received antibiotics > 36 hours over all infants > 35 weeks admitted in the NICU within 3 days of birth each month. All NICU admits > 35 weeks during the pre-intervention period (Jan 2022-Jun 2023) and post-intervention period (Jul 2023-Dec 2024) were included. The primary drivers were organizational commitment and culture, evidence-based clinical practice guidelines for diagnosing and treating EOS, culture change and regular reporting of antibiotics use and monitoring progress. The 36-hr ASO was implemented following the process of Plan-Do-Study-Act cycle. Data were collected and reported monthly.

Results: The implementation of 36-hr ASO for antibiotics resulted in a significant reduction in AUR by 33% in all NICUS, from a monthly average of 12.7% in the pre-intervention period to 8.5% in the post-intervention period (p=0.001). A decrease in AUR by NICU level of care are as follows: 19.7% to 14.0% in surgical NICUs, 4.7% to 3.4% in non-surgical level 3 NICUs, and 6.3% to 2.6% in level 2 NICUs. The most significant reduction was seen in the last 6 months with AUR at 3.4% (p < 0.001) for all units, 5.3% (p < 0.001) for surgical, 1.5% (p=0.005) for non-surgical level 3, and 1.7% (p < 0.001) for level 2 NICUs. There was no apparent increase in infection-related mortality and unintentional treatment interruption due to a missed re-order.

Conclusion(s): The ASO as key component of this multi-center ASP quality improvement initiative was highly effective in decreasing antibiotic usage in all KFH-SCAL NICUs with no inadvertent adverse outcomes.

P-CHART: ALL NICUs % AUR > 36 hrs Pre-Intervention (Jan 2022-Jun 2023) vs Post-Intervention (Jul 2023-Dec 2024)
Antibiotic Use Beyond 36 hrs-All NICUs

P-CHART: Surgical NICUs % AUR > 36 hrs Pre-Intervention (Jan 2022-Jun 2023) vs Post-Intervention (Jul 2023-Dec 2024)
Antibiotic Use Beyond 36 hrs- Surgical NICUs

P-CHART: Level 3 NICUs % AUR > 36 hrs Pre-Intervention (Jan 2022-Jun 2023) vs Post-Intervention (Jul 2023-Dec 2024)
Antibiotic Use Beyond 36 hrs- Level 3 NICUs