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Published on: August 7, 2017
Antimicrobial exposure during infancy in a longitudinal California cohort
Hannah C Barca1, Jeannette Ferber2, Megan Richards3
1School of Public Health, University of Nevada, Reno, Reno, NV, USA. hannahcbarca@gmail.com.
Insights
Antimicrobial exposure in infants decreased over time, driven by fewer late-infancy outpatient prescriptions. Early infancy exposure is linked to birth factors, while later infancy exposure relates to sociodemographics.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Antimicrobial exposure patterns in infants are not well-described in US populations.
- Understanding these patterns is crucial for public health and clinical practice.
Purpose of the Study:
- To describe temporal and sociodemographic patterns of antimicrobial exposure in the first year of life.
- To identify predictors of antimicrobial exposure in early versus late infancy.
Main Methods:
- Longitudinal analysis of 345,550 infants born 1998-2014 in a large US integrated health system.
- Utilized comprehensive electronic health records for inpatient and outpatient antimicrobial dispensings.
- Summarized exposure by maternal/infant characteristics, birth year, inpatient/outpatient status, age, and drug class.
Main Results:
- 44% of infants received at least one antimicrobial dose.
- Antimicrobial exposure decreased over time, primarily due to reduced late-infancy outpatient dispensings (penicillins).
- Early infancy (0-3 months) exposure strongly predicted by birth characteristics (NICU, gestational age); late infancy (3-12 months) exposure modestly predicted by sociodemographics.
Conclusions:
- Predictors of antimicrobial exposure differ between early and late infancy.
- Early infancy exposures are strongly correlated with birth characteristics.
- Decreased cumulative infant antimicrobial exposure is linked to reduced late-infancy outpatient dispensings.
Background:
To describe temporal and sociodemographic patterns of antimicrobial exposure during the first year of life in a large US cohort.
Methods:
Singleton infants born 1998-2014 enrolled in Kaiser Permanente Northern California integrated health system (n = 345,550) were followed longitudinally via comprehensive electronic health records, capturing all systemic antimicrobial inpatient administrations and outpatient dispensings. Antimicrobial exposure was summarized by maternal and infant characteristics, birth year, inpatient/outpatient status, age in months, and drug class.
Results:
Overall, 44% of infants in this cohort received at least one dose of antimicrobials during infancy. Decreases over time were driven by reduced outpatient dispensings specifically in later infancy, primarily for penicillins. Among infants receiving any antimicrobials the median number of exposure-days was 16. Inpatient dispensings peaked in the first 30 days of life and outpatient dispensings peaked at 10-11 months. Birth characteristics (i.e., NICU admission, gestational age) were strong independent predictors of antimicrobial exposure between 0- < 3 months; sociodemographic factors were modest predictors of exposure for 3-12 months.
Conclusion:
Predictors of antimicrobial exposure in early and late infancy are distinct with early infancy exposures highly correlated to birth characteristics. The cumulative proportion of infants exposed has decreased due to fewer late infancy outpatient dispensings.
Impact:
Comprehensive antimicrobial exposure histories and the maternal and infant characteristics predicting exposure have not been well described in US populations. This analysis provides estimates of cumulative antimicrobial exposures by sociodemographic factors, delivery characteristics, month of life, inpatient/outpatient status, and antibiotic class among one of the largest US HMOs. Predictors of early infancy antimicrobial exposures differ from those in late infancy, with early exposures strongly correlated to birth characteristics and late infancy exposures modestly related to sociodemographic factors. Antimicrobial exposure among infants decreased over the time period primarily due to reduced outpatient dispensings in later infancy.
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