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Procalcitonin-Based Antibiotic Use for Neonatal Early-Onset Bacterial Infections: Pre- and Post-Intervention Clinical
Hidetoshi Go1, Nobuhiko Nagano1, Yuki Sato1
1Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 1738610, Japan.
Insights
New diagnostic criteria using serum procalcitonin (PCT) effectively reduced antibiotic use in newborns. The criteria proved safe and effective for diagnosing early-onset bacterial infections without increasing infection rates.
Area of Science:
- Neonatal Medicine
- Clinical Diagnostics
- Infectious Disease
Background:
- Early-onset bacterial infection is a critical concern in neonatal intensive care units.
- Accurate diagnosis is essential to guide appropriate antibiotic therapy and prevent overuse.
Purpose of the Study:
- To verify the effectiveness of novel diagnostic criteria based on serum procalcitonin (PCT) for early-onset bacterial infection.
- To compare antibiotic use and infection incidence before and after the introduction of new PCT criteria.
Main Methods:
- Retrospective study of newborns in a neonatal intensive care unit (2018-2022).
- Comparison of antibiotic use (DOT, percentage) and infection rates between pre-intervention (n=737) and post-intervention (n=686) groups.
- Utilized the 95th percentile cutoff of the serum PCT reference curve for diagnosis.
Main Results:
- The post-intervention group showed significantly lower antibiotic use: 82.0 DOT/1000 patient days vs. 211.3 DOT/1000 patient days (p < 0.01).
- Fewer newborns received antibiotics in the post-intervention group (12% vs. 38%, p < 0.01).
- Incidence of early-onset bacterial infections remained similar between groups (2% each, p = 0.99).
Conclusions:
- The novel diagnostic criteria using serum PCT are safe and effective for managing early-onset bacterial infections.
- Implementation of these criteria promotes appropriate antibiotic stewardship in neonates.
- Reduced antibiotic exposure without compromising infection detection rates.
Abstract:
We previously reported the 95th percentile cutoff value of the serum procalcitonin (PCT) reference curve for diagnosing early-onset bacterial infection. We aimed to verify the effectivity of these novel diagnostic criteria by comparing antibiotic use and incidence of early-onset bacterial infection between pre- and post-introduction periods. We included newborns admitted to our neonatal intensive care unit who underwent blood tests within 72 h after birth between 2018 and 2022. The neonates were divided into the pre-intervention (admitted before the introduction, n = 737) or post-intervention (admitted after the introduction, n = 686) group. The days of antibiotics therapy (DOT) per 1000 patient days up to 6 days after birth, percentage of antibiotic use, and incidence of early-onset bacterial infection were compared between the groups. The post-intervention group had significantly lower DOT per 1000 patient days (82.0 days vs. 211.3 days, p < 0.01) and percentage of newborns receiving antibiotics compared with the pre-intervention group (79 (12%) vs. 280 (38%), respectively, p < 0.01). The incidence of early-onset bacterial infections did not differ between the groups (2% each, p = 0.99). In conclusion, our diagnostic criteria using the 95th percentile cutoff value of the serum PCT reference curve for early-onset bacterial infection were proven safe and effective, promoting appropriate use of antibiotics.
