# Implementing vancomycin-sparing regimens in preterm infants

> **NIH AHRQ R01** · CHILDREN'S HOSP OF PHILADELPHIA · 2024 · $492,654

## Abstract

PROJECT SUMMARY/ABSTRACT
Antibiotics are the most prescribed medication in neonatal intensive care units (NICU). Antibiotic stewardship
efforts have reduced overall antibiotic use in the NICU, but preterm and low birth weight infants have not
benefited proportionately. Preterm infants (≤35 week gestation) constitute ~45% of all NICU admissions, are
admitted for extended periods, are frequently exposed to antibiotics, are at higher risk for antibiotic side effects
and serve as reservoirs for multi-drug resistant pathogens. Thus, interventions to optimize antibiotic use in
preterm infants can reduce unit-level selection pressure and improve patient safety. Despite recommendations
from the American Academy of Pediatrics against its empirical use in the NICU, vancomycin is the most
common antibiotic administered to preterm infants after 3 days of age, largely as empiric therapy for suspected
late-onset sepsis (LOS). Studies by us and others demonstrate that use of vancomycin reducing protocols
(VRP), designed to encourage the use of narrower spectrum antibiotics as first-line empiric and provide
guidance for when vancomycin is an appropriate choice, can safely reduce vancomycin use in the NICU. Yet
these regimens are not universally adopted, and when adopted are not universally applied, highlighting the
need for more comprehensive strategies to implement change. Our long-term goal is to identify and promote
practices that optimize antibiotic use in neonates. Our broad objective is to implement a VRP in NICUs for safe
and sustained reduction of unnecessary vancomycin use in preterm infants (≤35 weeks). We hypothesize that
VRP implemented by preparing local champions, educational outreach, introduction of a clinical decision
support tool and providing unit-level audit and feedback will reduce vancomycin use (Aim 1); and that the use
of additional external facilitation will improve fidelity and acceptability of VRP use (Aim 2). We used the
updated Consolidated Framework for Implementation Research (CFIR) to design this study and simultaneously
use CFIR constructs to understand barriers and facilitators of VRP use (Aim 3). We will comprehensively
examine antibiotic use in the context of VRP implementation including evaluation of implementation outcomes,
disparity drivers, and parent and clinician perspectives. We will conduct this study in 13 NICUs across two
large healthcare networks. Our specific aims are 1) To reduce unnecessary vancomycin use in preterm
infants by implementing a VRP in a quasi-experimental trial; 2) To determine the effect of external
facilitation on the fidelity of using VRP and other implementation outcomes in a cluster randomized
trial; and 3) To identify barriers and facilitators to implementation of the VRP across NICUs. By using an
implementation science approach to reduce vancomycin in a multicenter study we will provide a road map for
the broader implementation of VRP across NICUs in the United States. Additionally, our study...

## Key facts

- **NIH application ID:** 10882802
- **Project number:** 1R01HS029500-01A1
- **Recipient organization:** CHILDREN'S HOSP OF PHILADELPHIA
- **Principal Investigator:** Sagori Mukhopadhyay
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2024
- **Award amount:** $492,654
- **Award type:** 1
- **Project period:** 2024-04-01 → 2029-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10882802

## Citation

> US National Institutes of Health, RePORTER application 10882802, Implementing vancomycin-sparing regimens in preterm infants (1R01HS029500-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10882802. Licensed CC0.

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