Active antibiotic discontinuation in suspected but not confirmed early‐onset neonatal sepsis—A quality improvement initiative

Aim - To study whether a simple targeted intervention could reduce unwarranted antibiotic treatment in near‐term and term neonates with suspected, but not confirmed early‐onset sepsis. Methods - A quality improvement initiative in three Norwegian neonatal intensive care units. The intervention included an inter‐hospital clinical practice guideline for discontinuing antibiotics after 36‐48 hours if sepsis was no longer suspected and blood cultures were negative in neonates ≥ 34+0 weeks of gestation. Two units used procalcitonin in decision‐making. We compared data 12‐14 months before and after guideline implementation. The results are presented as median with interquartile ranges. Results - A total of 284 infants (2.5% of all births ≥ 34+0 weeks of gestation) received antibiotics before and 195 (1.8%) after guideline implementation (P = .0018). The two units that used procalcitonin discontinued antibiotics earlier after guideline implementation than the unit without procalcitonin. Neonates not diagnosed with sepsis were treated 49 (31‐84) hours before and 48 (36‐72) hours after guideline implementation (P = .68). In all infants, including those diagnosed with sepsis, antibiotic treatment duration was reduced from 108 (60‐144) to 96 (48‐120) hours (P = .013). Conclusion - Antibiotic treatment duration for suspected, but not confirmed early‐onset sepsis did not change. However, treatment duration for all infants and the proportion of infants commenced on antibiotics were reduced.