Antimicrobial utilization in very-low-birth-weight infants: association with probiotic use

Area of Science:

• Neonatal Medicine
• Microbiology
• Pharmacology

Background:

• Antimicrobial resistance is a growing concern in neonatal intensive care units.
• Very-low-birth-weight (VLBW) infants are particularly vulnerable to infections and often require broad-spectrum antibiotics.
• Optimizing antimicrobial stewardship in this population is crucial.

Purpose of the Study:

• To investigate the association between probiotic administration and antimicrobial utilization rates in VLBW infants.
• To determine if probiotic use impacts the duration of antibiotic exposure in this vulnerable population.

Main Methods:

• Retrospective evaluation of VLBW infants admitted to Canadian tertiary neonatal intensive care units from 2014 to 2019.
• Antimicrobial utilization rate (AUR) defined as days of antimicrobial exposure per 1000 patient-days.
• Comparison of AUR between infants who received probiotics and those who did not.

Main Results:

• Of 16,223 VLBW infants, 45% received probiotics, with usage increasing from 10% to 68% between 2014 and 2019.
• Probiotic use was associated with a significantly lower AUR (107 vs. 129 per 1000 patient-days; adjusted risk ratio [aRR] = 0.89).
• In a subgroup analysis excluding sepsis and necrotizing enterocolitis, probiotic use also showed a significant reduction in AUR (78 vs. 97 per 1000 patient-days; aRR = 0.85).

Conclusions:

• Probiotic administration is linked to a significant decrease in antimicrobial utilization among VLBW infants.
• These findings support the potential role of probiotics in antimicrobial stewardship programs for neonates.
• Further research may explore the mechanisms underlying this association.