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Antibiotic use among extremely low birth-weight infants from 2009 to 2021: a retrospective observational study
Dustin D Flannery1,2, Alvaro Zevallos Barboza3, Sagori Mukhopadhyay3,2
1Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA flanneryd@chop.edu.
Insights
Antibiotic use in extremely low birth-weight infants remained stable, but duration of therapy significantly decreased. This highlights successful stewardship efforts and the need for better infection risk identification in neonatal intensive care units.
Area of Science:
- Neonatal Medicine
- Pediatric Infectious Diseases
- Health Services Research
Background:
- Antibiotic resistance is a growing global concern.
- Neonatal intensive care units (NICUs) frequently use antibiotics for extremely low birth-weight (ELBW) infants.
- Optimizing antibiotic use in vulnerable neonates is critical.
Purpose of the Study:
- To analyze trends in antibiotic exposure and duration of therapy (DOT) for ELBW infants in US NICUs over 13 years.
- To evaluate the impact of stewardship interventions on antibiotic consumption.
- To identify areas for improved infection management strategies in neonates.
Main Methods:
- A repeated cross-sectional cohort study design was employed.
- Data were sourced from the Premier Health Database, encompassing inpatient encounters from academic and community US hospitals.
- Analysis included 36,701 ELBW infants admitted to 402 NICUs between 2009 and 2021.
Main Results:
- The proportion of ELBW infants exposed to antibiotics remained largely unchanged (89.9% in 2009 to 89.3% in 2021).
- Antibiotic days of therapy (DOT) per 1000 patient days significantly decreased by 37.8% (from 337 to 210).
- Infant mortality rates did not change during the study period.
Conclusions:
- Substantial reductions in antibiotic DOT were achieved without altering the overall proportion of exposed infants.
- These findings suggest successful antibiotic stewardship programs targeting duration.
- Further research is needed to refine methods for identifying ELBW infants at highest risk of infection.
Objective:
To assess trends in antibiotic use across a large cohort of extremely low birth-weight (<1000 g; ELBW) infants admitted to academic and community neonatal intensive care units (NICUs) across the USA over a 13-year period.
Design:
Repeated cross-sectional cohort study.
Setting:
Premier Health Database, a comprehensive administrative database of inpatient encounters from academic and community hospitals across the US.
Patients:
ELBW inborn infants admitted to NICUs from 1 January 2009 to 31 December 2021.
Interventions:
N/A MAIN OUTCOME MEASURES: Absolute and relative changes in (1) proportion of ELBW infants with antibiotic exposure and (2) days of therapy (DOT) per 1000 patient days, over time. Average annual differences were estimated using generalised linear regression with 95% CI. Disposition trends were also measured.
Results:
Among 36 701 infants admitted to 402 NICUs, the proportion exposed to antibiotics was essentially unchanged (89.9% in 2009 to 89.3% in 2021; absolute reduction of -0.6%); generalised linear regression estimated an annual absolute difference of -0.3% (95% CI (-0.6%) to (-0.07%); p=0.01). DOT per 1000 patient days decreased from 337 in 2009 to 210 in 2021, a 37.8% relative difference and annual relative difference of -4.3% ((-5.2%) to (-3.5%); p<0.001). Mortality was unchanged during the study period.
Conclusions:
We found a substantial reduction in antibiotic DOT despite no substantive change in the proportion of infants exposed to antibiotics. This suggests the success of stewardship efforts aimed at antibiotic duration and highlight the need for improved approaches to identifying ELBW infants at highest risk of infection.
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