October 16, 2023
2 min read
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Key takeaways:
- The proportion of infants who received antibiotics in NICUs fell from 54.8% in 2009 to 35.9% in 2021.
- NICUs saw a drastic decrease in cefotaxime use.
Antibiotic stewardship efforts are likely responsible for a substantial decline in antibiotic use in neonatal ICUs, researchers reported in JAMA Pediatrics.
“Antibiotics are widely used in NICUs, and the field has been working to optimize use of these medications among newborns, including large-scale antibiotic stewardship efforts in collaboration with national organizations,” Dustin D. Flannery, DO, MSCE, a pediatric neonatologist at The Children’s Hospital of Philadelphia (CHOP), told Healio. “We wanted to try to get a sense of whether there have been any big-picture changes in antibiotic use in NICUs.”
Flannery and colleagues conducted a repeated cross-sectional cohort study using a database of inpatient encounters with available pharmacy charge data. Infants were included if they were born between Jan. 1, 2009, and Dec. 31, 2021, and admitted to the NICU in the same facility as a birth.
The researchers determined the proportion of newborns who received any antibiotics, specific antibiotics, and also determined the days of therapy per 1,000 patient days. Antibiotic exposure was defined as a charge for at least one dose of a parenteral antibiotic.
The cohort included a total of 1,395,791 infants from 735 NICUs — just over half of the 1,424 NICUs in the United States. The researchers found that, overall, 44.8% of infants in NICUs received antibiotics, with the most commonly prescribed antibiotics being ampicillin, gentamicin, vancomycin and cefotaxime.
The percentage of infants in NICUs who received antibiotics fell from 54.8% in 2009 to 35.9% in 2021, with an annual absolute decline of 1.9% (95% CI, –2.6% to –1.3%)
In the study, Flannery and colleagues said the decreases “likely reflect the penetration of national calls for neonatal antibiotic stewardship efforts and refined early-onset infection risk-assessment strategies.”
“We were pleasantly surprised by the decline in the proportion of newborns in the NICU who received antibiotics,” Flannery said. “We were also pleased to see a decrease in the use of vancomycin, which has been a specific target for neonatal antibiotic stewardship.
The researchers also found what Flannery called “a drastic decrease” in the use of cefotaxime.
“We used to prescribe this drug often in the NICU, but it was discontinued by the FDA during the study period,” Flannery said. “Unfortunately, our results show that broader spectrum cephalosporin drugs are being used in its place. This demonstrates how drug manufacturing changes can impact stewardship efforts.”
Flannery is interested in seeing continued surveillance of antibiotic use in NICUs, but correlated with infection epidemiology.
“We want to make sure we maintain a careful balance of limiting unnecessary antibiotic use without missing infections and leading to patient harm,” Flannery said. “Also, large-scale organism antibiotic susceptibility data are needed to help inform empiric antibiotic decisions in the NICU.”
He said the study showed “all of the work that is being done to improve antibiotic use in NICUs, including work by national organizations as well as individual units, is paying off.”
“But there is definitely more work to do,” Flannery said.
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Sources/Disclosures
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Disclosures:
Flannery reports receiving a grant from the Agency for Healthcare Research and Quality and access to the Premier Healthcare Database from The Children’s Hospital of Philadelphia during the conduct of the study. The other authors report no relevant financial disclosures.
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