Implementation of quality improvement principles for antimicrobial stewardship program in the level III B neonatal intensive care unit of a tertiary care public hospital

Sumit Jeena; Amol Kalyanrao Joshi; Atul C. Londhe; Laxmikant Sheshrao Deshmukh; Hemant N. Patil

doi:10.18203/2349-3291.ijcp20261912

Authors

Sumit Jeena Department of Pediatrics, Soban Singh Jeena, Government Medical College and Research Centre, Almora, Uttarakhand, India
Amol Kalyanrao Joshi Department of Neonatology, Government Medical College, Chhatrapati Sambhaji Nagar, Maharashtra, India
Atul C. Londhe Department of Neonatology, Government Medical College, Chhatrapati Sambhaji Nagar, Maharashtra, India
Laxmikant Sheshrao Deshmukh Department of Neonatology, Government Medical College, Chhatrapati Sambhaji Nagar, Maharashtra, India
Hemant N. Patil Department of Neonatology, Government Medical College, Chhatrapati Sambhaji Nagar, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20261912

Keywords:

Multidrug-resistant organisms, Plan-do-study-act, Preauthorization, De-escalation, Antibiograms

Abstract

Background: Antibiotic overuse in neonatal intensive care units (NICUs) is associated with increased mortality, multidrug-resistant organisms (MDROs) and adverse neurodevelopmental outcomes. This study aimed to implement and evaluate a Quality improvement (QI)-based Antimicrobial stewardship program (AMSP) to reduce unnecessary antibiotic use in a busy public sector NICU in Chhatrapati Sambhaji Nagar in Central Maharashtra, India.
Methods: A quasi-experimental interrupted time-series study was conducted from July 2024 to June 2025. After a 2-month baseline phase, AMSP interventions were implemented through nine sequential Plan–do–study–act (PDSA) cycles, including standardized antibiotic policy, early discontinuation of antibiotics at 48-72 hours, preauthorization for higher antibiotics and de-escalation based on blood culture. This intervention phase lasted for 7 months, followed by a 3-month sustenance phase. The primary outcome was Antibiotic usage rate (AUR; Days of therapy per 1000 patient-days).
Results: Among 3696 neonates (52.2% male; median GA 37.6 weeks; median birth weight 1990 g), baseline admission-antibiotic exposure was 63.66%. After implementation, admission-antibiotic exposure decreased to 56.73% (p=0.0075) and AUR decreased from 540.09 to 441.71 (18.21% relative reduction, p=0.0018). Culture-negative AUR decreased by 10.50%. Early discontinuation in screen-negative neonates increased from 14.4% to 29.15% (p<0.0001). Two outbreaks (Klebsiella pneumoniae, Candida tropicalis) occurred during implementation and were controlled through revised antibiograms and antifungal protocols.

Conclusions: Structured Point-of-care-quality improvement (POCQI)-based AMSP implementation reduced antibiotic use in this high-burden NICU. AMSP scale-up across Indian NICUs is urgently warranted.

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