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Published on: February 17, 2023
Antibiotic Utilization and Infection Among Infants with Abdominal Wall Defects
Chandana Ravikumar1, Ian C Mitchell2, Joseph B Cantey1
1From the Departments of Pediatrics.
Insights
Neonates with abdominal wall defects often receive prophylactic antibiotics, but infection risk and antibiotic use require better quantification. Strategies are needed to optimize antibiotic stewardship in these high-risk infants.
Area of Science:
- Neonatal surgery
- Pediatric infectious diseases
- Clinical pharmacology
Background:
- Neonates with abdominal wall defects (AWDs) face elevated infection risks due to the defect and prolonged NICU stays.
- Antibiotic prophylaxis is commonly administered until defect closure, but its necessity and impact are not well-defined.
- Quantifying infection rates and antibiotic utilization in this vulnerable population is crucial.
Purpose of the Study:
- To retrospectively analyze infection risks and antibiotic use in neonates with gastroschisis and omphalocele.
- To quantify the patterns and duration of antibiotic prophylaxis and treatment in infants with AWDs.
- To evaluate the incidence of infections during and after antibiotic prophylaxis.
Main Methods:
- Retrospective cohort study of 74 neonates with gastroschisis or omphalocele from 2007-2018.
- Collected demographic, clinical, and microbiological data, including antibiotic dosing and surgical care.
- Quantified antibiotic use via days of therapy (DOT) per 1000 patient-days; defined sepsis by pathogen culture.
Main Results:
- All 74 infants received antibiotics, with a median of 24.5 DOT/infant (416.5 DOT/1000 patient-days).
- Preclosure prophylaxis (44%) and small intestinal bowel overgrowth treatment (24%) dominated antibiotic use; infections accounted for 26%.
- Common infections included skin/soft tissue (18%) and late-onset sepsis (15%); 2 infants had sepsis on prophylaxis.
Conclusions:
- Antibiotic use in neonates with AWDs is predominantly prophylactic.
- While infection during prophylaxis was rare, 35% of infants developed infections post-prophylaxis.
- Enhanced antibiotic stewardship strategies are essential for managing infection risk in these high-risk neonates.
Background:
Neonates with abdominal wall defects are at an increased infection risk because of the defect itself and prolonged neonatal intensive care unit (NICU) stays. Antibiotic prophylaxis until closure of the defect is common. However, infection risk and antibiotic use have not been well quantified in these infants.
Methods:
A retrospective cohort study of infants with abdominal wall defects (gastroschisis and omphalocele) admitted to a single-center NICU from 2007 to 2018. Demographic and clinical information, including microbiologic studies, antibiotic dosing and surgical care, were collected. Antibiotic use was quantified using days of therapy (DOT) per 1000 patient-days. Sepsis was defined as culture of a pathogen from a normally sterile site.
Results:
Seventy-four infants were included; 64 (86%) with gastroschisis and 10 (14%) with omphalocele. Median day of closure was 8 days [interquartile range (IQR) 6-10, range 0-31]. All infants received ≥1 course of antibiotics; median antibiotic DOT/infant was 24.5 (IQR 18-36) for an average of 416.5 DOT per 1000 patient-days. Most antibiotic use was preclosure prophylaxis (44%) and treatment of small intestinal bowel overgrowth (24%). Suspected and proven infection accounted for 26% of all antibiotic use. Skin and soft tissue infection (13/74, 18%) and late-onset sepsis (11/74, 15%) were the most common infections; 2 infants had sepsis while on antibiotic prophylaxis. All infants survived to discharge.
Conclusions:
Most antibiotic use among infants with abdominal wall defects was prophylactic. Infection on prophylaxis was rare, but 35% of infants had infection after prophylaxis. Improved stewardship strategies are needed for these high-risk infants.
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