Research In Practice Blog
Intro
Antibiotic stewardship programs combat antimicrobial resistance, reduce polypharmacy, and improve patient outcomes. For neonatal intensive care (NICU) providers, the programs can be particularly impactful—extremely low birth-weight (ELBW) infants have high rates of exposure, and preemptive prescribing while awaiting infection confirmation is common. Individual systems have reported success with guidelines and strategies for judicious antibiotic use, but a large-cohort retrospective observational study to quantify changes over time was recently conducted by Dr. Dustin Flannery and his colleagues.
Study design & findings
The research team conducted a repeated cross-sectional cohort study using records from 36,701 ELBW infants admitted to 402 NICUs from January 1, 2009 to December 31, 2021. They measured absolute and relative changes in annual proportions of infants with antibiotic exposure and days of therapy (DOT) per 1000 patient days, over time. They also looked at prescribing and disposition trends.
Findings included a nearly 38% reduction in antibiotic days of therapy, but no substantive change in the proportion of infants exposed to antibiotics. While cefotaxime use declined by nearly 90%, cefazolin, ceftazidime, and cefepime use increased by 268%, 163%, and 254%, respectively. Overall, antibiotic use rate decreased from 20% to 13% and median length of stay increased from 68 days to 80 days.
Among infants who survived to discharge, antibiotic exposure slightly decreased, and days of therapy significantly decreased. Among infants who died, overall DOT was more than three times higher than infants who survived and the annual proportion of antibiotic exposure did not change over time.
Research in Practice Implications
This study's purpose was to assess trends in antibiotic use across a cohort of ELBW infants admitted to academic and community NICUs. Findings demonstrate both success and opportunities in antibiotic stewardship.
Actionable Insights:
- Clinical: Continue stewardship approaches… Refine… Introduce
- Research: Conduct comparative effectiveness studies to provide evidence needed to reduce duration of treatment for specific conditions. Research pharmacokinetics of antibiotics at specific gestational and postnatal ages. Explore clinical adoption of recommended approaches to infection risk assessment, antibiotic choice, and diagnostic stewardship. Improve assessment of risk of early-onset sepsis among pre-term infants.
Information & Resources
Antibiotics Publications by other Clinical Futures members
Clinical Futures author(s):
Dustin D Flannery, DO, MSCE; Alvaro Zevallos Barboz, MPH; Sagori Mukhopadhyay, MD, MMSc; Jeffrey S Gerber, MD, PhD; Karen M Puopolo, MD, PhD
Additional study author(s) from Children’s Hospital of Philadelphia:
Molly McDonough, Di Shu, PhD; Kelly C Wade, MD, PhD, MSCE
Citation:
Flannery DD, Zevallos Barboza A, Mukhopadhyay S, et al. Antibiotic use among extremely low birth-weight infants from 2009 to 2021: a retrospective observational study. Archives of Disease in Childhood - Fetal and Neonatal Edition Published Online First: 20 July 2024. doi: 10.1136/archdischild-2023-326734