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Antibiotic Overuse in Premature Low Birth Weight Infants in a Developing Country
Maria S Rueda1, Renzo Calderon-Anyosa1, Jorge Gonzales1
1From the Universidad Peruana Cayetano Heredia, Lima, Peru.
Insights
Premature infants in Peru often receive prolonged antibiotic treatment for late-onset sepsis, with overuse linked to lower birth weight. Vancomycin and carbapenems were frequently used, highlighting the need for antimicrobial stewardship programs.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Neonatal sepsis is a major cause of mortality in premature infants.
- Inappropriate antibiotic use contributes to bacterial resistance and poor outcomes.
- Understanding antibiotic patterns in neonatal sepsis is crucial for effective treatment.
Purpose of the Study:
- To describe antibiotic utilization for late-onset sepsis in Peruvian premature infants.
- To identify patterns and trends in antibiotic use.
- To inform the development of antimicrobial stewardship programs.
Main Methods:
- Prospective analysis of a clinical trial cohort.
- Inclusion of premature infants (birth weight <2000g) in Peruvian neonatal care units.
- Measurement of antibiotic use by length of therapy (LOT) per 1000 patient days (PD) and number of antibiotic courses.
Main Results:
- Antibiotic use for late-onset sepsis was 196 LOT/1000 PD among 408 neonates.
- Lower birth weight was significantly associated with increased antibiotic use (P < 0.001).
- Vancomycin, carbapenems, and aminoglycosides were the most frequently prescribed antibiotics.
Conclusions:
- Premature infants frequently receive antibiotics for extended durations.
- Antibiotic overuse is more pronounced in neonates with lower birth weights.
- Development of antimicrobial stewardship programs is urgently needed in this setting.
Background:
Neonatal sepsis is a leading cause of child morbidity and mortality, especially in premature and low birth weight infants. Prompt antibiotic therapy is warranted, but its inappropriate use leads to bacterial resistance and adverse outcomes. Our objective is to describe the antibiotic use for late-onset sepsis in Peruvian premature infants.
Methods:
This study is a prospective study as a secondary analysis of a clinical trial in 3 neonatal care units in Peru. We included infants in the first 72 hours of life, with birth weight (BW) <2000 g. We described the antibiotic use as length of therapy (LOT) per 1000 patient days (PD) and antibiotic courses.
Results:
We included 408 neonates, with 12,204 PD of follow-up; 253 infants (62%) had a BW ≤1500 g. Total antibiotic use for late-onset sepsis was 2395 LOT (196 LOT/1000 PD). Two-hundred and seventy-one patients (66.4%) did not receive antibiotics for late-onset sepsis during their hospitalization. In total, 204 antibiotic courses were administered; 92 infants (22.5%) received 1 course, and 45 (11.0%) received 2-5 antibiotic courses. Mean duration of antibiotic course was 10.8 days (standard deviation: ±7.3). We found a significant association between a lower BW and increased antibiotic use per day (P < 0.001). The most commonly used antibiotics were vancomycin (143 LOT/1000 PD), carbapenems (115 LOT/1000 PD), aminoglycosides (72 LOT/1000 PD) and ampicillin (41 LOT/1000 PD).
Conclusions:
Premature infants receive antibiotics for longer than recommended periods of time. Antibiotic overuse is greater in neonates with lower BW. Vancomycin is the most used antibiotic. There is an urgent need to develop antimicrobial stewardship programs in our setting.
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