Short-course antibiotic therapy for pneumonia in the neonatal intensive care unit.

OBJECTIVE: To determine the adherence and safety outcomes of a 5-day antibiotic course with a "time-out" for treatment of "blood culture-negative" pneumonia in the NICU. STUDY DESIGN: Prospective surveillance of all infants diagnosed with pneumonia at 7 NICUs from 8/2020-12/2021. Safety outcomes were defined a priori by re-initiation of antibiotic therapy within 14 days after discontinuation and overall and sepsis-related mortality. RESULTS: 128 infants were diagnosed with 136 episodes of pneumonia; 88% (n = 119) were treated with 5 days of definitive antibiotic therapy. Antibiotics were restarted within 14 days in 22 (16%) of the 136 pneumonia episodes. However, only 3 (3%) of the 119 episodes of pneumonia treated for 5 days had antibiotics restarted for pneumonia. Mortality was 5% (7/128); 5 of the 7 deaths were assessed as sepsis-related. CONCLUSION: Adherence to the 5-day definitive antibiotic treatment for "culture-negative" pneumonia was high and the intervention seemed safe.

Short-course empiric antibiotic therapy for possible early-onset sepsis in the NICU.

OBJECTIVE: On 2/2019, the Neonatal Antimicrobial Stewardship Program at Nationwide Children's Hospital recommended reducing empirical antibiotic therapy for early-onset sepsis (EOS) from 48 to 24 hours with a TIME-OUT. We describe our experience with this guideline and assess its safety. METHODS: Retrospective review of newborns evaluated for possible EOS at 6 NICUs from 12/2018-7/2019. Safety endpoints were re-initiation of antibiotics within 7 days after discontinuation of the initial course, positive bacterial blood or cerebrospinal fluid culture in the 7 days after antibiotic discontinuation, and overall and sepsis-related mortality. RESULT: Among 414 newborns evaluated for EOS, 196 (47%) received a 24 hour rule-out sepsis antibiotic course while 218 (53%) were managed with a 48 hour course. The 24-hour rule-out group were less likely to have antibiotics re-initiated and did not differ in the other predefined safety endpoints. CONCLUSION: Antibiotic therapy for suspected EOS may be discontinued safely within 24 hours.

Implementation of an electronic pharmacy scoring tool to prioritize clinical pharmacists' daily workflow at a pediatric institution.

PURPOSE: To describe the development and implementation of an electronic pharmacy scoring tool (PST) to prioritize patients requiring clinical pharmacy intervention and assist in workload management in a freestanding pediatric hospital using quality improvement methodology. SUMMARY: The department of pharmacy at Nationwide Children's Hospital developed a pediatric-specific PST within the electronic medical record to aid in patient prioritization and ensuring proficient daily workflow and qualifying workload for clinical pharmacists. The PST identifies patients for monitoring of high-risk medications, complex medication regimens, or abnormal laboratory values related to medication management. Application of the scoring tool ensures each patient is reviewed by clinical pharmacy staff each day, with initial efforts focused on patients with significant clinical pharmacy needs. This tool reduces the need for time-intensive manual chart review for identification of patients whose medication use and/or laboratory values afford greater opportunity for pharmacist intervention. Additionally, clinical pharmacist productivity metrics and workloads are considered, with the qualifying of patient care activities and quantification of time spent on patient review. CONCLUSION: A PST enhances pediatric patient prioritization for clinical pharmacists by identifying patients most likely to require intervention in real time. The scoring tool enables future assessment of clinical pharmacists' workload assignments and better quantifies time spent on patient care activities.