388Antibiotic Stewardship in the Neonatal Intensive Care Unit (NICU): Metrics Matter!

Background. Prolonged antibiotic therapy among preterm infants in the NICU is associated with adverse outcomes including death and necrotizing enterocolitis. The optimal metric to measure antibiotic use in the NICU and thus guide stewardship efforts is unknown. The purpose of this study was to apply two different metrics of antibiotic use to a large cohort of NICU infants and compare the results. Methods. Prospective collection and analysis of all antibiotics provided to every infant admitted to the NICU at Parkland Memorial Hospital, Dallas during a 14 month period (SCOUT study). Pertinent clinical and outcome data were collected. Two different metrics for determining antibiotic use were calculated for all antibiotics: 1) days of therapy (DOT) and 2) number of calendar days (CD) that the antibiotics were administered. DOT was calculated by dividing the dosing interval by 24 hours, then multiplying by the number of doses, summed for each antibiotic. CD was determined by the number of days in which a dose of an antibiotic was administered. For example, a 6dose course of q8 hour ampicillin begun Monday evening and completed Wednesday morning would equal 2 DOT (8 ÷ 24 x 6 = 2) and 3 CD (Monday, Tuesday, Wednesday = 3). Results. 1521 infants were admitted during the study period; 364 (24%) received no systemic antibiotics and were excluded. 1157 infants (76%) accounted for 19,788 hospital days and received 1439 separate antibiotic courses. The total volume of antibiotic administered was 9394 by DOT and 5915 by CD. Agent-specific antibiotic use by DOT and CD is shown (table).