Variation in NICU antibiotic use not linked to outcomes

1. Antibiotic use across 127 neonatal intensive care units (NICU) in California varied 40-fold, ranging from 2.4% to 97.1% of patient-days, with a median of 24.5% of patient-days.

2. Variations in antibiotic use were not linked to rates of proven infection, NEC, mortality, proportion of live births admitted to the NICU, NICU specific surgical volume, or average length of stay.

Evidence Rating Level: 1 (Excellent)  

Study Rundown: Antibiotics are frequently used in the neonatal intensive care unit (NICU) when infection is suspected. Though important in treating suspected infections, antibiotics should be used judiciously as their use increases the risk of necrotizing enterocolitis (NEC), nosocomial infection, and selection towards drug-resistant pathogens. Previous literature has suggested that antibiotic use differs across NICUs, but has not correlated this to burden of proven infection. This study analyzed antibiotic use in many California NICUs and with researchers, finding a great variety in NICU antibiotic prevalence. However, despite variations in antibiotic use, the study did not find any statistical difference in rates of proven infection, NEC, mortality, proportion of live births admitted to the NICU, NICU specific surgical volume, or average length of stay. A major strength of this study was its inclusion of a wide population, including data from 127 of 133 NICUs in California, though the geographic limitation of this study makes it applicable to only regional microbial patterns. The results of this large study suggest that NICUs with a higher prevalence of antibiotic use are likely overutilizing antibiotics without clear benefit, and as such, stronger antibiotic stewardship programs would be advantageous.

Click to read the study published today in Pediatrics

Relevant Reading: Prolonged Duration of Initial Antibiotic Treatment Is Associated With Increased Rates of Necrotizing Enterocolitis and Death for Extremely Low Birth Weight Infants

In-Depth [retrospective cohort study]: This retrospective cohort study included 52 061 infants from 127 NICUs across California during the 2013 calendar year. Data was extracted from a combined database including NICUs that report to either or both the California Perinatal Quality Care Collaborative and California Children’s Services. Annual antibiotic use rates were utilized to find 214 323 / 746 051 patient-days of antibiotic exposure, with a median of 24.5%. Per individual NICU, the range of antibiotic patient-days was from 2.4% to 97.1% of patient-days. Despite great variation in patient-days of antibiotics, there were no statistically significant differences amongst all NICUs for early onset sepsis (p = 0.53), central line associated blood stream infection (p = 0.72), nosocomial infection (p = 0.95), fungal infection (p = 0.83), NEC (p = 0.86), mortality rate (p = 0.31), portion of live births admitted to NICU (p = 0.10), NICU-specific surgical volume (p = 0.16), or average length of stay (p = 0.50).

Image: PD

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