2025 Southeastern Residency Conference

Title: Evaluating the Safety and Efficacy of an Automatic 24-hour Stop Date for Antibiotics in the Treatment of Early-Onset Sepsis in the Neonatal Intensive Care Unit


Authors: Tyler Tolbert, Corinne Murphy, McKenzie Hodges, Darryl Wanton Jr.


Background: Early-Onset Sepsis (EOS) remains a significant concern in the neonatal intensive care unit (NICU), necessitating the use of empiric antibiotic therapies. However, prolonged antibiotic exposure is associated with adverse neonatal outcomes including disruption of normal flora, increased incidence of antibiotic resistance, and increased risk for necrotizing enterocolitis. Previous practice included 72 hours of empiric antibiotics for EOS which caused an increase in duration of therapy even though typical pathogens can be identified within 24 hours. Our institution previously had an automatic stop date of 36 hours for EOS antibiotics, but we recently transitioned to an automatic stop date of 24 hours for EOS antibiotics in order to reduce unnecessary drug exposure. This study evaluated the safety and efficacy of implementing a 24-hour automatic stop date for empiric antibiotics in neonates suspected of EOS compared to the previous 36-hour protocol. 

Methods: This study was a single-center, retrospective, pre/post-implementation chart review. Neonates receiving antibiotics for EOS were categorized into two groups based on treatment periods: pre-implementation (36-hour protocol) and post-implementation (24-hour protocol). The primary outcome was treatment failure, defined as the resumption of antibiotics within 72 hours of discontinuation. Secondary outcomes included the incidence of necrotizing enterocolitis, mortality, and length of hospital stay. Data on neonatal demographics, antibiotic duration, and clinical outcomes were collected and analyzed. Comparative analyses using chi-squared and t-tests were used to assess statistical significance between the two groups.
 
Results: For our primary outcome of treatment failure there was no statistical difference in the incidence of treatment failure between a 24 hour automatic stop date and a 36 hour automatic stop date for empiric antibiotics. For our secondary outcomes, late onset sepsis was not observed in either study group during the study period. There was also no statistical difference between the groups when analyzing the incidence of death which occurred in 9% of patients on 24-hour protocol and 10.5% of patients on the 36-hour protocol, or the incidence of necrotizing enterocolitis which occurred in 3% and 5.3% of patients respectively. The average length of stay was also not statistically significant between the groups, but there was a longer average length of stay during the 36 hour protocol time frame.

Conclusion: This study assessed the impact of implementing a 24-hour empiric antibiotic stop date for early-onset sepsis in the Neonatal Intensive Care Unit. The results showed that reducing the duration of empiric antibiotics from 36 to 24 hours was not associated with an increased rate of treatment failure. This is a significant finding because it suggests that a shorter antibiotic duration may be just as effective in ruling out early-onset sepsis while also reducing unnecessary antibiotic exposure.
 
Contact: tyler.tolbert@piedmont.org