P1.246: Implementation of Antibiotic Stewardship Program in Kaiser Permanente Southern California Neonatal Intensive Care Units: 3-Year Regional Quality Improvement Project

Purpose/Objectives: Background
Antibiotic stewardship programs (ASPs) are critically necessary for optimizing responsible antibiotic use and combating antimicrobial resistance. In vulnerable populations such as neonates in the neonatal intensive care units (NICUs), 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.
Objectives
1) To safely reduce antibiotic use for early onset sepsis (EOS) to < 15% or a decrease of 2% from baseline 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). We defined AUR as the number of infants > 35 weeks gestation who were admitted to NICU within 3 days of birth and received antibiotics > 36 hours divided by the total number of 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/Discussion: 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.