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Wide variation in antibiotic use found in US NICUs

A review of US neonatal intensive care units (NICUs) shows wide variability in antibiotic use in newborns, researchers reported yesterday in Infection Control and Hospital Epidemiology.

The cross-sectional analysis of 51 US NICUs participating in the Pediatric Health Information System found that, on the day of the study (Oct 25, 2017), among 2,813 hospitalized newborns, 656 (23%) received at least one antibiotic, and 345 (12%) received more than one antibiotic.

Across all 51 NICUs, the prevalence of antibiotic use ranged from 0% to 59%. Ampicillin (25%), gentamicin (19%), vancomycin (10%), and cefazolin (7%) were the most prescribed antibiotics.

The proportions of newborns receiving at least one antibiotic were highest in the West (26%) and Northeast (26%), followed by the South (24%) and Midwest (19%).

Of the 656 newborns receiving an antibiotic on the study day, 169 (26%) received a broad-spectrum antibiotic. Broad-spectrum antibiotic use ranged from 0% to 27% across NICUs, with 8 NICUs reporting no broad-spectrum antibiotic use on the study day.

The proportions of infants receiving antibiotics were similar among those 30 days and younger (23%) and those 30 days and older (26%). Overall antibiotic use was greater in patients admitted to surgical compared with medical service lines (28% vs 20%).

Substantial decline noted

Antibiotic use in NICUs is common, particularly in premature infants, who are highly susceptible to a range of bacterial infections. A 2018 study by researcher with Children’s Hospital of Philadelphia found that almost 80% of premature infants are exposed to early antibiotic treatment.

But other studies have indicated that up to one third of newborns receive an inappropriate antibiotic during hospitalization.

The authors of yesterday’s study, which was led by researchers from the Vanderbilt University Medical Center, note that the overall observed rate of antibiotic use (23%) is substantially lower than the 46% reported in a similar study conducted in 2005, suggesting that antibiotic use in US NICUs has declined, although differences in study designs limit direct comparisons.

The authors say the decline could be associated with increased recognition of the adverse consequences of early-life antibiotics, which have been linked in recent years to later development of allergies, diabetes, obesity, and inflammatory bowel syndrome. They also cite increased implementation of antibiotic stewardship programs in NICUs, quality improvement collaboratives, universal group B Streptococcus screening, and preventive intrapartum antibiotics as possible factors.

The authors add, however, that the wide variation in antibiotic use they observed across NICUs needs further examination.

“In conclusion, our study has demonstrated substantial variability in antibiotic use among NICUs,” they wrote. “Additional studies are needed to identify drivers of variability to guide antibiotic stewardship efforts and mitigate adverse consequences of inappropriate antibiotic exposure in early life.”

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