Evaluation of Compliance with Gastroschisis and Intestinal Atresia Antibiotic Use Guidelines

Corresponding Author Kelley Lee, Pharm.D., BCPS, Clinical Pharmacy Specialist - Antimicrobial Stewardship; Le Bonheur Children's Hospital, 848 Adams, Memphis, TN 38103; 901-287-5969, kelley.lee@lebonheur.org Funding None. Conflict(s) of Interest No conflicts to disclose. Background Since 2017, US News and World Report has measured compliance with appropriate perioperative antibiotic use in gastroschisis and bowel atresia. Our guidelines were jointly developed by our antimicrobial stewardship (ASP) and neonatal intensive care unit (NICU) teams and implemented in 2023. Methods Neonates with gastroschisis or intestinal atresia were identified via the Children’s Hospitals Neonatal Database. For our analysis, 2021 and 2022 were considered pre-guideline, and 2023 and 2024 were considered post-guideline. Our gastroschisis guidelines recommend discontinuation of antibiotics within 24 hours of admission, as all silos are placed upon admission. In addition, after surgical closure prophylactic antibiotics should be discontinued within 24 hours. For intestinal atresia repair, we only recommend standard surgical prophylaxis. Electronic medical records were reviewed for antibiotic duration, timing of surgical procedures, cultures, and reported indication for antibiotic continuation. Compliance with our institutional guidelines was assessed. Results Gastroschisis: There were 28 neonates, 18 and 10 admitted pre- and post-guideline implementation, respectively. Antibiotic discontinuation within 24 hours of silo placement occurred in 0% and10% in the pre- and post-periods. The most common reason for non-compliance was completion of a NICU sepsis rule out/culture-negative sepsis treatment. Antibiotic discontinuation within 24 hours of surgical closure occurred in 17% and 40% in the pre- and post-guideline periods, respectively. The most common reason for non-compliance post- surgical closure was extended surgical prophylaxis (Table 1). There were no positive cultures in any patient. Intestinal atresia: There were 51 neonates, 24 and 27 admitted pre- and post-guideline implementation, respectively. Antibiotic discontinuation within 48 hours of repair occurred in 71% and 81% in the pre- and post-periods, respectively. The most common reason for non-compliance was NICU sepsis rule out/culture-negative sepsis treatment (Table 2). One positive blood culture with P. aeruginosa, obtained immediately prior to the atresia diagnosis was found in the pre-implementation group and antibiotics were continued post-operatively. Conclusion Limited practice changes have occurred since guideline implementation for these patients. The most common reason for guideline non-compliance in each cohort was a NICU sepsis rule out/culture-negative sepsis treatment. Extended post-operative prophylaxis also continues to be common practice. The next steps are to identify the drivers of the antibiotic overuse so they can be appropriately addressed by the ASP team.