Interventions by Clinical Pharmacists Reduced Unnecessary Antibiotics Exposure for Early-Onset Sepsis in a Neonatology Department.

Abstract

Aim: To observe the effect of pharmacist-led antimicrobial stewardship (AMS) on antibiotic exposure for infants with suspected early-onset sepsis (EOS).

Methods: A retrospective observational study was performed. The pharmacist was responsible for the development, education, and supervision of the implementation of the local EOS management protocol. In phase 1, the protocol was established completely according to the latest domestic consensus. In phase 2, the protocol was updated and defined which steps should be taken for specific risk factors and situations in which antibiotics were not necessary down to the detail.

Results: A total of 9880 neonates were enrolled. The antibiotic use rate decreased from 58.1% before AMS was implemented to 51.9% in phase 1, and further to 31.7% in phase 2 (p < 0.0001). Days of therapy per 100 patient days were 30.8, 28.3, and 24.8, respectively (p < 0.0001). Multidrug-resistant organism culture rate gradually decreased from 48.2% to 45.5% in phase 1, and further to 37.0% in phase 2 (p < 0.01). No difference in safety outcomes was observed between the intervention and baseline periods.

Conclusion: A practical AMS led by a pharmacist can safely and successfully reduce the prescription rate of antibiotics for EOS and the incidence of multidrug-resistant bacteria.