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Related Experiment Video

Updated: Apr 14, 2026

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Neonatal intensive care unit antibiotic use.

Joseph Schulman1, Robert J Dimand2, Henry C Lee3

  • 1California Department of Health Care Services, California Children's Services, Sacramento, California; joseph.schulman@dhcs.ca.gov.

Pediatrics
|April 22, 2015
PubMed
Summary

NICU antibiotic prescribing varied widely, unrelated to infection rates. Overuse in some NICUs correlated with higher admission rates and longer stays, suggesting unnecessary antibiotic use.

Keywords:
antibiotic stewardshipbacterial infections and mycosesbenchmarkinghealth services researchneonatal intensive care

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Area of Science:

  • Neonatal care
  • Infectious disease management
  • Healthcare quality improvement

Background:

  • Antibiotic stewardship is crucial in Neonatal Intensive Care Units (NICUs).
  • Significant variation in antibiotic prescribing practices exists among NICUs.
  • The relationship between antibiotic use and patient outcomes requires further investigation.

Purpose of the Study:

  • To investigate the correlation between antibiotic prescribing variation in NICUs and key clinical outcomes.
  • To examine the association between antibiotic use and rates of infection, necrotizing enterocolitis (NEC), and mortality.
  • To explore the relationship between antibiotic prescribing patterns and NICU surgical volume and length of stay.

Main Methods:

  • Retrospective cohort study of 52,061 infants across 127 California NICUs in 2013.
  • Comparison of sample means and correlation analysis of antibiotic use with clinical outcomes.
  • Stratification by NICU level of care and antibiotic use quartiles.

Main Results:

  • Antibiotic use varied 40-fold (2.4%-97.1% of patient-days), independent of proven infection, NEC, or mortality.
  • NICUs in the highest antibiotic use quartile had significantly higher inborn admission rates (218% increase) and longer lengths of stay (35% increase).
  • Many NICUs in the highest quartile reported zero infections, indicating potential overuse.

Conclusions:

  • Wide variation in NICU antibiotic prescribing exists despite similar infection burdens, suggesting overuse in some units.
  • A significant portion of antibiotic use in NICUs may lack clear clinical justification.
  • Further research is needed to define appropriate antibiotic use ranges and understand contributing factors.