"Less is more": decreasing antibiotic days in the NICU.

Decreasing antibiotic days, mortality, and sepsis-related mortality are critical goals for our patients in the neonatal intensive care unit (NICU). In a prospective design, this small study in a single NICU evaluated the implementation of diagnostic criteria for early-onset sepsis (EOS) and lateonset sepsis (LOS), focused on stopping antibiotics early if hematologic and CRP tests were within the normal range for neonates. The study by Pinto et al.1 targeted stopping antibiotics after 48 hours versus treating for a full course in culture-negative ‘‘possible infections’’. This is important, as ‘‘possible infections’’ likely drives antibiotic usage and days. This study reduced EOS antibiotic days primarily by defining fewer EOS evaluations as ‘‘possible infections’’, which roughly translated into receiving two days instead of seven days of antibiotics in the first week after birth. LOS antibiotic days and diagnosis of LOS were not affected. This remains a challenging area. These findings are similar to studies of CLABSI bundles, which while demonstrating lower CLABSI rates, have not lowered antibiotic usage.2 This may be partially explained in that most studies examining antibiotics and sepsis in the NICU do not include information on the definition of sepsis used and data on