P27 Minimising blood sampling by grouping gentamicin and c-reactive protein tests

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Aim National Institute for Health and Care Excellence (NICE) guideline NG195, ‘Neonatal infection: antibiotics for prevention and treatment’ 1, states that trough levels for the aminoglycoside antibiotic gentamicin should be known before the 2nd dose is administered, 36 hours after the first dose (target level <2mg/L).1 The aim of this audit was to establish whether this gentamicin level can be taken, together with the 2nd c-reactive protein test (CRP), at 18-24 hours post dose, to reduce the frequency of blood sampling and improve the patient and family experience.Method Dosing and levels data was obtained from the drug chart and the electronic laboratory recording system, ICE™. All results were analysed using Microsoft Excel™.Results Data was collected from 116 newborn infants cared for solely on the post-natal wards, born between 13/3/24 and 12/6/24 inclusive. Mean gestation at birth: 39+4 weeks (34+3 to 42+2 weeks). Mean birth weight: 3.47Kg (2.215Kg to 4.62Kg). 219 doses were administered with a mean time between the 1st dose and gentamicin level of 24 hours 13 minutes (10 hours 35 minutes to 45 hours 25 minuets). 61% of initial gentamicin levels were <2mg/L, and nearly 80% of patients had a gentamicin level <2mg/L by 36 hours post dose. Analysis of the scatter plots showed no evidence of a linear relationship between initial gentamicin levels and gestation, or initial gentamicin levels and weight. 8.8% of patients did not have a repeat level as the antibiotic course was stopped.11 of the patients that required repeat (2nd) gentamicin levels had them taken more than 36 hours post dose. For 7 out of these 11 patients, the gentamicin level was <2mg/L when taken up to and including 37.5 hours post dose, with the highest level being 1.85mg/L at 37 hours 15 minutes. The other 4 patients had a 2nd (repeat) level taken between 43 and 93 hours post dose.38.6% of patients required repeat gentamicin levels, totalling 161 blood tests compared to 232 which would have been required if the 2nd CRP and gentamicin trough level were taken separately.Conclusion Patients require a 2nd CRP at 18-24 hours post partial septic screen, so grouping the gentamicin level with this test reduced the number of blood samples required by 31%, leading to improved patient and family experience.A reduction in tests results in cost savings for the Trust, as well as improved nursing flow due to fewer delays in waiting for the 36 hour trough gentamicin levels in 61% of patients.Reference National Institute for Health and Care Excellence. NG195. Neonatal infection: antibiotics for prevention and treatment [online]. 2021. https://www.nice.org.uk/guidance/ng195 (accessed 01 July 2025).

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