Institutional Practices Drive Antibiotic Variability in Neonatal Intensive Care Units: Baseline Evidence to Inform...

Area of Science:

• Neonatalogy
• Infectious Diseases
• Public Health

Background:

• Antibiotic overuse in Neonatal Intensive Care Units (NICUs) contributes to antimicrobial resistance and poor neonatal outcomes.
• Evaluating baseline antibiotic utilization (AU) is crucial for developing effective stewardship programs.

Purpose of the Study:

• To assess baseline antibiotic utilization (AU) across multiple NICUs.
• To identify factors influencing variability in AU.
• To determine the impact of neonatal characteristics and sepsis incidence on AU.

Main Methods:

• A multicenter retrospective analysis of 25,532 neonatal admissions from 2019-2023.
• Collected data on neonatal clinical parameters, sepsis incidence, and AU metrics (DOT/1000 patient-days).
• Utilized correlation and multivariate regression to identify determinants of antibiotic use.

Main Results:

• 43.8% of neonates received antimicrobials, with significant inter-NICU variation (24%-73%).
• Antimicrobial-exposed neonates were more premature and had lower birth weights.
• Multivariate analysis indicated NICU practice patterns, not neonatal demographics, significantly predicted AU.

Conclusions:

• Significant variation in neonatal antimicrobial use exists among NICUs, primarily due to institutional practices.
• Findings provide baseline data for national antimicrobial stewardship interventions.
• Offers transferable lessons for optimizing antibiotic use in NICUs globally to combat antimicrobial resistance.