First name
Molly
Middle name
R
Last name
Passarella

Title

Delivery-based criteria for empiric antibiotic administration among preterm infants.

Year of Publication

2020

Date Published

2020 Aug 13

ISSN Number

1476-5543

Abstract

<p><strong>OBJECTIVE: </strong>Determine impact of using delivery criteria to initiate antibiotics among very low birth weight (VLBW) and extremely low birth weight (ELBW) infants. STUDY&nbsp;DESIGN: Single site cohort study from 01/01/2009 to 01/31/2020. After 04/2017, infants delivered by Cesarean section, without labor or membrane rupture were categorized as low-risk for early-onset infection and managed without empiric antibiotics. We determined effect of this guideline by pre-post, and interrupted time-series analyses.</p>

<p><strong>RESULTS: </strong>After 04/2017, antibiotic initiation ≤3 days decreased among low-risk VLBW (62% vs. 13%, p &lt; 0.001) and low-risk ELBW (88% vs. 21%, p &lt; 0.001) infants. In time series analysis, guideline was associated with decreased initiation among low-risk ELBW infants. In contrast, low-risk VLBW infants demonstrated decreased antibiotic initiation throughout study period. Incidence of confirmed infection, death, or transfer ≤7 days age was unchanged.</p>

<p><strong>CONCLUSION: </strong>Delivery criteria may be used to optimize early antibiotic initiation among preterm infants without short-term increase in adverse outcomes.</p>

DOI

10.1038/s41372-020-00784-y

Alternate Title

J Perinatol

PMID

32792629

Title

Influence of Patient Characteristics on Antibiotic Use Rates Among Preterm Infants.

Year of Publication

2020

Date Published

2020 Mar 14

ISSN Number

2048-7207

Abstract

<p><strong>BACKGROUND: </strong>The antibiotic use rate (AUR) has emerged as a potential metric for neonatal antibiotic use, but reported center-level AURs are limited by differences in case mix. The objective of this study was to identify patient characteristics associated with AUR among a large cohort of preterm infants.</p>

<p><strong>METHODS: </strong>Retrospective observational study using the Optum Neonatal Database, including infants born from January 1, 2010 through November 30, 2016 with gestational age 23-34 weeks admitted to neonatal units across the United States. Exposures were patient-level characteristics including length of stay, gestational age, sex, race/ethnicity, bacterial sepsis, necrotizing enterocolitis, and survival status. The primary outcome was AUR, defined as days with ≥ 1 systemic antibiotic administered divided by length of stay. Descriptive statistics, univariable comparative analyses, and generalized linear models were utilized.</p>

<p><strong>RESULTS: </strong>Of 17 910 eligible infants, 17 836 infants (99.6%) from 1090 centers were included. Median gestation was 32.9 (interquartile range [IQR], 30.3-34) weeks. Median length of stay was 25 (IQR, 15-46) days and varied by gestation. Overall median AUR was 0.13 (IQR, 0-0.26) and decreased over time. Gestational age, sex, and race/ethnicity were independently associated with AUR (P &lt; .01). AUR and gestational age had an unexpected inverse parabolic relationship, which persisted when only surviving infants without bacterial sepsis or necrotizing enterocolitis were analyzed.</p>

<p><strong>CONCLUSIONS: </strong>Neonatal AURs are influenced by patient-level characteristics besides infection and survival status, including gestational age, sex, and race/ethnicity. Neonatal antibiotic use metrics that account for patient-level characteristics as well as morbidity case mix may allow for more accurate comparisons and better inform neonatal antibiotic stewardship efforts.</p>

DOI

10.1093/jpids/piaa022

Alternate Title

J Pediatric Infect Dis Soc

PMID

32170951

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