Background: Prolonged or unnecessary antibiotic use is associated with adverse outcomes in neonates. Our objectives were to quantify all antibiotic use in a Level-III neonatal intensive care unit and to identify scenarios where their use could be reduced.
Methods: Surveillance and evaluation of all antibiotic use provided to every infant admitted to a Level-III neonatal intensive care unit from 10/3/11 to 11/30/12 was performed. Types of antibiotics, reasons for their initiation, discontinuation and duration, as well as clinical, laboratory and outcome data were recorded. Antibiotic use was quantified by days of therapy (DOT) per 1000 patient-days (PD).
Results: A total of 1607 infants were included. The total antibiotic use was 9165 DOT (343.2 DOT/1000 PD; 5.7 DOT/infant). Seventy-two percent of infants received 1 (43%) or more (29%) courses of antibiotics. Gentamicin (46%), ampicillin (39%) and oxacillin (8%) were the most frequently used agents. Ninety-four percent of antibiotic use (323 DOT/1000 PD) was empiric therapy for suspected infection. Sixty-three percent (216.2 DOT/1000 PD) was discontinued at approximately 48 hours when cultures were sterile (68% >48 hours, 32% ≤48 hours). Twenty-six percent of all antibiotic use (89.4 DOT/1000 PD) was therapy for ≥5 days despite sterile cultures; pneumonia (16%) and “culture-negative” sepsis (8%) were the major contributors. Five percent (17.4 DOT/1000 PD) of antibiotic use was for culture-proven sepsis, 5% (16.6 DOT/1000 PD) was penicillin prophylaxis for group B Streptococcus and 1% (3.5 DOT/1000 PD) was preprocedural prophylaxis.
Conclusions: Narrow-spectrum therapy accounted for >92% of antibiotic use and would not be monitored by most stewardship programs. Only 5% of antibiotic usage was due to culture-proven infection. Pneumonia and “culture-negative” sepsis were frequent reasons for prolonged therapy; further study of these conditions may allow reduction in treatment duration.
From the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
Accepted for publication August 8, 2014.
Pablo J. Sánchez, MD is currently at the Center for Perinatal Research, Nationwide Children’s Hospital—The Ohio State University, Columbus, Ohio.
This work was supported by a Gerber Novice Researcher Award through the Gerber Foundation, #5200762201. The Gerber Foundation had no role in the design or conduct of the study, collection or analysis of data, writing of this manuscript, or in the decision on where to submit the manuscript.
The authors have no other funding or conflicts of interest to disclose.
This study was presented in part at the Pediatric Academic Society Annual Meeting; May 4–7, 2013; Washington, DC.
Address for correspondence: Joseph B. Cantey, MD, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9063. E-mail: email@example.com.