Antibiotic Stewardship Quality Improvement Project for Neonatal Sepsis in a Tertiary NICU in Lima, Peru.

Introduction: Preterm newborns in neonatal intensive care units face high antibiotic exposure despite low culture positivity. To address this, the National Maternal and Perinatal Institute, Peru, and the Andean Health Organization launched a project to reduce neonatal antibiotic use by 20% from May 2023 to May 2024. Method: A quality improvement project was designed at the National Maternal and Perinatal Institute in collaboration with the Andean Health Organization as part of a multinational initiative. The project used key driver identification and Plan-Do-Study-Act cycles to enhance antibiotic stewardship in early-onset sepsis (EOS) and late-onset sepsis (LOS) cases. Monitoring focused on identifying cases of treatment failure, recurrence, and mortality rate. We present results on Laney p'-charts stratified by EOS and LOS for the antibiotic use rate. Newborn characteristics are presented in comparative tables by sepsis type. Results: We included 647 newborns for suspected sepsis, comprising 982 episodes. Antibiotic use decreased by 17.3% for EOS and 25.9% for LOS. In EOS, rule-out sepsis was predominant (67.2%), whereas confirmed sepsis was predominant in LOS (40.6%). EOS was more common in term infants with a birth weight of 1,500 to 2,500 g, whereas LOS was predominant in preterms younger than 32 weeks with a birth weight of 1,000 to 1,500 g. No treatment failures or early recurrent sepsis were observed after discontinuation of antibiotics. No readmissions occurred within 30 days. EOS mortality was 15.8% and LOS mortality was 20.2%, with a decline in overall mortality from 3.5 to 3.0 per 1,000 live births across semesters. Conclusions: The quality improvement project improved neonatal sepsis management, reduced antibiotic use, and optimized treatment protocols.