BACKGROUND AND OBJECTIVES Many sick neonates receive antibiotics for the clinical diagnosis of probable/possible sepsis. Reports suggest rampant antibiotic use in culture-negative sepsis. We introduced an antibiotic stop policy (ASP), by defining 'completed course duration of antibiotics' in the setting of culture-negative suspected healthcare-associated infection (HAI). Antibiotic overuse days (AOD) before antibiotic stop policy (BASP) and after antibiotic stop policy (AASP) were compared. METHODS This descriptive analytical study was conducted to measure the change in AOD after implementing ASP in culture-negative HAI. We also sought to evaluate situations in which antibiotic overuse is likely (lower gestation, ventilation, central lines) and safety of the ASP, measured as not having to restart antibiotics in the week following completed course. RESULTS A total of 126 neonates were initiated on a new antibiotic (started or changed) for suspected HAI. Of these, 43 were excluded. Patient days of 5175 and 5208 were analyzed in BASP and AASP, respectively. Implementation of an ASP reduced AOD (from 14.49 to 3.26 AOD per 1000 patient days; p value <0.01). Safety was ensured; the number of babies who had to be restarted on antibiotics within 1 week of stopping therapy was similar in both groups. All-cause mortality and relevant morbidities were comparable between groups. CONCLUSIONS A significant decrease in AOD after the introduction of an ASP was noted, in neonates with culture-negative suspected HAI. This difference was noted even in the most vulnerable extreme preterm babies and those requiring ventilation and central lines.

中文翻译：

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通过“停止”政策优化抗生素在培养阴性医疗保健相关感染中的使用：一项描述性分析研究。

背景和目的 许多患病新生儿接受抗生素治疗以进行可能/可能败血症的临床诊断。报告表明在培养阴性败血症中大量使用抗生素。我们通过在培养阴性疑似医疗保健相关感染 (HAI) 的情况下定义“抗生素的完整疗程持续时间”，引入了抗生素停止政策 (ASP)。比较了抗生素停用政策 (BASP) 前和抗生素停用政策 (AASP) 后的抗生素过度使用天数 (AOD)。方法 这项描述性分析研究旨在测量在培养阴性 HAI 中实施 ASP 后 AOD 的变化。我们还试图评估可能过度使用抗生素的情况（低妊娠、通气、中心线）和 ASP 的安全性，测量为在完成课程后的一周内不必重新开始使用抗生素。结果 共有 126 名新生儿因疑似 HAI 而开始使用新抗生素（开始或更换）。其中，43 人被排除在外。在 BASP 和 AASP 中分别分析了 5175 天和 5208 天的患者天数。ASP 的实施减少了 AOD（从每 1000 个患者日 14.49 到 3.26 AOD；p 值 <0.01）。安全得到保障；两组婴儿在停止治疗后 1 周内必须重新开始使用抗生素的人数相似。全因死亡率和相关发病率在各组之间具有可比性。结论 在培养阴性疑似 HAI 的新生儿中，注意到在引入 ASP 后 AOD 显着降低。