Implementing Updated Intraamniotic Infection Guidelines at a Large Academic Medical Center

Background Intraamniotic infection (IAI) affects 2%-5% of pregnancies, causing significant neonatal and maternal morbidity. The American College of Obstetrics and Gynecology suggests ampicillin and gentamicin as first-line IAI treatment. Due to potential drug toxicity, changes in gentamicin susceptibility cutoff points, and rising Enterobacterales gentamicin and ampicillin resistance, changes in IAI antibiotic treatment were implemented at Vanderbilt University Medical Center.Methods Combination ampicillin, gentamicin, and clindamycin were replaced by piperacillin-tazobactam in institutional IAI treatment. Implementation strategies included repeated education sessions to gain stakeholder trust and buy-in and changing preexisting electronic clinical decision support tools (eCDSTs) to a default selection of piperacillin-tazobactam, capitalizing on highly reliable intervention strategies of forcing function and automatization/computerization. Change in antibiotic use, measured in days of therapy (DOT)/1000 patient-days present (1000PDP) by week initiated, before and after eCDST changes, was analyzed with interrupted time series analysis. Effects on hospital length of stay, repeat antibiotics within 14 days, and 30 day readmission were evaluated using multivariable linear and logistic regression.Results After updated eCDST go-live, piperacillin-tazobactam use increased by 1.9 DOT/1000PDP (95% CI, 0.7 to 3.1) by week initiated, and ampicillin, gentamicin, and clindamycin use decreased by -2.5 DOT/1000PDP (95% CI, -3.8 to -1.2) by week initiated. Hospital length of stay, repeat antibiotics within 14 days, and 30-day readmission rate did not significantly change.Conclusions Forced function changes to existing eCDSTs, supported by stakeholder education, successfully changed IAI empiric antibiotic use without unintended patient safety consequences. This study is a novel prospective quality improvement study for implementation of updated intraamniotic infection guidelines. Updated guidelines successfully replaced ampicillin/gentamicin/clindamycin with piperacillin-tazobactam using a clinical decision support tool. There was no significant change in patient safety outcomes.