Colorado Antibiotic Stewardship Collaborative – Neonatal Early Onset Sepsis (CASC-NEOS) QI Initiative
Under the umbrella of CPCQC, a number of Colorado birthing hospitals came together in 2015 to work as a state collaborative team as part of the Vermont Oxford Network (VON)/CDC Choosing Antibiotics Wisely QI initiative. This group became CASC (Colorado Antibiotic Stewardship Collaboration). When the Choosing Antibiotics Wisely initiative ended, many CASC hospitals continued their work to reduce unnecessary antibiotic exposure in Colorado’s hospitalized newborns.
To join CASC-NEOS or for more information, email firstname.lastname@example.org.
Antibiotic stewardship has been identified as a critical issue by the CDC because of worldwide increases in antibiotic resistance. In 2013, the CDC published a report stating that each year in the US, at least 2 million people get an antibiotic-resistant infection, and at least 23,000 people die from these infections (CDC 2013). In the neonatal setting, antibiotic exposure has been increasingly linked to adverse short- and long-term outcomes, including increased rates of necrotizing enterocolitis in premature neonates and increased rates of asthma, allergies, and obesity in childhood. Because this is viewed as a critical global issue, the CDC and the Vermont Oxford Network (VON) developed a collaborative QI platform for antibiotic stewardship in newborns (Choosing Antibiotics Wisely) that launched in 2015. CASC hospitals participated in the Choosing Antibiotics Wisely collaborative from 2015-2018.
Reference: Centers for Disease Control and Prevention. Online publication: Antibiotic Resistance Threats in the United States, 2013. U.S. Department of Health and Human Services. (https://www.cdc.gov/drugresistance/biggest_threats.html)
- Antibiotic Stewardship: Why we do it and How we’ve done it. C. Michael Cotten MD MHS Duke (SCRIBD Presentation)*
- The Neonatal Sepsis Risk Calculator: Development and Implementation (Puopolo 11/16/2017) (pdf)
*These resources provided by Perinatal Quality Collaborative of North Carolina (PQCNC) Antibiotic Stewardship/Neonatal Sepsis (ASNS) Initiative. (www.pqcnc.org)
Given the recent concerns about the hazards of antibiotic exposure, the American Academy of Pediatrics (AAP) published a Clinical Report in 2018 that proposed evidence-based approaches to sepsis risk assessment in newborns. The approach endorsed in the Clinical Report has been shown to reduce exposure to antibiotics by almost 50% in some settings, without demonstrated adverse effects such as missed cases of sepsis (Puopolo 2018). One of the endorsed methods described in the Clinical Report is risk stratification using the Sepsis Risk Calculator (SRC). The calculator is a validated tool and is used by hospitals around the world to reduce the number of babies unnecessarily exposed to antibiotics. This calculator helps to identify babies at higher risk for true infection in order to better target treatment.
Reference: Puopolo KM, Benitz WE, Zaotis TE (2018). AAP Clinical Report: Management of Neonates Born at >35 0/7 Weeks’ Gestation with Suspected or Proven Early-Onset Bacterial Sepsis. Pediatrics, 142(6). DOI:10.1542/peds.2018-2894.
Resources and Tools for Participating Providers & Hospitals:
Project Information and Documents
- CASC-NEOS Information Sheet (pdf)
- CASC-NEOS Timeline for Individual Hospital (pdf)
- CASC-NEOS Charter Part I (pdf)
- CASC-NEOS Project Charter Part II (pdf)
- CASC-NEOS Project Charter Part II With Sample Answers (pdf)
- CASC-NEOS Key Driver Diagram (pdf)
Patient Family Engagement Resources
- Antibiotics and Your Baby (video)
- 5 Questions to Ask Your Baby’s Doctor Before Your Baby is Given Antibiotics (pdf)
Other Helpful Resources
- Sepsis Risk Calculator- Guidance to Determine the Risk Estimate at Birth (pdf)
- Kaiser Calculator (Sepsis Risk Calculator) Demo (vimeo)*
- Blood cultures (vimeo)*
- AUR Calculation Examples (pdf)
Examples of clinical guidelines:
Sepsis Risk Calculator Implementation Tools
- SCL Health guideline “Management of Early Onset Sepsis for the Newborn”Mgmt of Early Onset Sepsis
- Classification of Clinical Presentation (PDF)
- Clarifications of Antibiotics Terms in Sepsis Risk Calculator (PDF)
- Early Onset Sepsis Empiric Antibiotic Dosing Recommendations (PDF)
- Intrapartum Antibiotic Recommendations (PDF)
Partners & Participants
CPCQC thanks the Vermont Oxford Network for supplying the iNICQ 2015-2018 project and providing discounts to both VON and non-VON Colorado hospitals for participation.