Metrics for NICU antibiotic use: which rate is right?

Schulman, Joseph D.; Saiman, Lisa

doi:10.1038/jp.2011.10

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…Our results rely on the continuous recording of all data regarding prescriptions. Overall values calculated for DOT and ASI were similar to those found in other studies (Schulman and Saiman, 2011;Gerber et al, 2017;Bizzarro, 2018;Schulman et al, 2018;Cailes et al, 2018). Moreover, all metrics of antibiotics use are inversely correlated to GA in this study.…”

Section: Discussionsupporting

confidence: 90%

“…Therefore, limiting uncontrolled antibiotics use in NW is currently one of the main objectives for all hospital teams as well as professional authorities, hospital administration, public health organizations, and researchers. Indeed, many studies, including a recent French survey (Leroux et al, 2015), indicate that antibiotics use varies widely between NICUs (Schulman and Saiman, 2011;Flannery and Puopolo, 2018). This variability has led to two essential questions from many authors about antibiotics use in NICUs: "how much is too much-or too little?"…”

Section: Introductionmentioning

confidence: 99%

“…This variability has led to two essential questions from many authors about antibiotics use in NICUs: "how much is too much-or too little?" or "when to start and when to stop" (Schulman and Saiman, 2011;Bizzarro, 2018;Flannery and Puopolo, 2018;Dona et al, 2020). Answers are complex and do not simply rely on some strict universal measures for improving antibiotics use in NICU.…”

Section: Introductionmentioning

confidence: 99%

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Antibiotics Prescription Over Three Years in a French Benchmarking Network of 23 Level 3 Neonatal Wards

Martin-Mons¹,

Lorrain²,

Iacobelli³

et al. 2021

Front. Pharmacol.

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Introduction: Prescribing antibiotics to newborns is challenging, as excess antibiotics are a risk factor for increased morbidity and mortality. The objective of this study was to describe the evolution of antibiotic exposure over three years in a large network of level 3 neonatal wards where each center is informed yearly of its own results and the results of other centers and has full autonomy to improve its performance.Patients and Methods: This is a prospective, observational study of antibiotics prescriptions over the 2017–2019 period in a network of 23 French level 3 neonatal wards. The network relied on an internal benchmarking program based on a computerized prescription ordering system. Among others, antibiotics exposure, treatment duration, and antibiotics spectrum index were analyzed.Results: The population consisted of 39,971 neonates (51.5% preterm), 44.3% of which were treated with antibiotics. Of the treated patients, 78.5% started their first antibiotic treatment in the first three days of life. Antibiotic exposure rate significantly declined from 2017 to 2019 (from 46.8% to 42.8%, p < 0.0001); this decline was significant in groups with gestational age >26 weeks, but not in the group with extremely low gestational age <27 weeks. Gentamicin, cefotaxime, amoxicillin (ampicillin), vancomycin, and amikacin were the antibiotics most prescribed. The lower the gestational age, the higher the exposure for cefotaxime, vancomycin, and amikacin. Compared to 2017, cefotaxime exposure in 2019 declined by 12.6%, but the change was only significant in the gestational age group of 32–36 weeks (17.4%) and at term (20.3%). The triple combination of antibiotics in the first three days decreased by 28.8% from 2017 to 2019, and this was significant in each gestational age group. During the study, the delayed ending of antibiotics in unconfirmed early-onset neonatal infection increased from 9.6% to 11.9%.Conclusion: This study showed that a strategy characterized by the collection of information via a computerized order-entry system, analysis of the results by a steering committee representative of all neonatal wards, and complete autonomy of neonatal wards in the choice of prescription modalities, is associated with a significant reduction in the use of antibiotics in newborns with gestational age greater than 26 weeks.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Antibiotics Prescription Over Three Years in a French Benchmarking Network of 23 Level 3 Neonatal Wards

Martin-Mons¹,

Lorrain²,

Iacobelli³

et al. 2021

Front. Pharmacol.

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“…The goal of such benchmarking efforts should be to identify warranted ranges of AUR for NICUs providing different levels of care. 38 Additional study is also needed to elucidate the determinants and directionality of relationships between AUR and other resource use.…”

Section: Discussionmentioning

confidence: 99%

Neonatal Intensive Care Unit Antibiotic Use

et al. 2015

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BACKGROUND AND OBJECTIVES: Treatment of suspected infection is a mainstay of the daily work in the NICU. We hypothesized that NICU antibiotic prescribing practice variation correlates with rates of proven infection, necrotizing enterocolitis (NEC), mortality, inborn admission, and with NICU surgical volume and average length of stay. METHODS:In a retrospective cohort study of 52 061 infants in 127 NICUs across California during 2013, we compared sample means and explored linear and nonparametric correlations, stratified by NICU level of care and lowest/highest antibiotic use rate quartiles.RESULTS: Overall antibiotic use varied 40-fold, from 2.4% to 97.1% of patient-days; median = 24.5%. At all levels of care, it was independent of proven infection, NEC, surgical volume, or mortality. Fifty percent of intermediate level NICUs were in the highest antibiotic use quartile, yet most of these units reported infection rates of zero. Regional NICUs in the highest antibiotic quartile reported inborn admission rate 218% higher (0.24 vs 0.11, P = .03), and length of stay 35% longer (90.2 days vs 66.9 days, P = .03) than regional NICUs in the lowest quartile.CONCLUSIONS: Forty-fold variation in NICU antibiotic prescribing practice across 127 NICUs with similar burdens of proven infection, NEC, surgical volume, and mortality indicates that a considerable portion of antibiotic use lacks clear warrant; in some NICUs, antibiotics are overused. Additional study is needed to establish appropriate use ranges and elucidate the determinants and directionality of relationships between antibiotic and other resource use.

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“…Although advances in neonatal care have resulted in improved survival of preterm infants, neonatal mortality remains about 3-fold higher in VLBW infants developing sepsis compared to infants without sepsis. In case of sepsis suspicion, decisions regarding initiation and duration of antibiotic treatment remain a major challenge because clinical signs are often uncharacteristic and unspecific [4]. …”

Section: Introductionmentioning

confidence: 99%

Molecular Detection of Late-Onset Neonatal Sepsis in Premature Infants Using Small Blood Volumes: Proof-of-Concept

et al. 2013

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Background: Conventional blood culture is still the gold standard for sepsis diagnosis but results are not immediately available and pathogens are only detected in approximately 25% of cases. New molecular assays for the detection of blood stream pathogens are promising diagnostic tools. Objectives: The aim of the study was to adapt and evaluate a multiplex PCR system using 100 µl blood. -Methods: 46 blood specimens of very low birth weight infants (818 ± 242 g) with suspected sepsis were analyzed using the Roche SeptiFast MGRADE PCR with a modified DNA extraction protocol and software handling tool for decreased blood volume requirements. Results: In the non-infected group, 5/21 infants had a positive PCR result with coagulase-negative staphylococci. All pathogens detected in the blood culture positive group (n = 15) were also detected by PCR. In addition, 4/6 patients had a positive PCR result in the clinical sepsis group (clinical and laboratory signs of sepsis but negative blood culture). Overall, the PCR was demonstrated to have a higher sensitivity (90.5%; 95%CI 68.2-98.3%) in comparison to blood culture (71.4%; 95%CI 47.7-87.8%) including clinical sepsis cases, even though it had a lower specificity (80.0%; 95%CI 58.7-92.4% versus 100.0%; 95%CI 83.4-100.0%). Conclusions: These first data demonstrate the usability and potential benefit of this multiplex PCR using a modified DNA extraction for the rapid detection of nosocomial sepsis in preterm infants in addition to blood culture.

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Metrics for NICU antibiotic use: which rate is right?

Cited by 6 publications

References 17 publications

Antibiotics Prescription Over Three Years in a French Benchmarking Network of 23 Level 3 Neonatal Wards

Antibiotics Prescription Over Three Years in a French Benchmarking Network of 23 Level 3 Neonatal Wards

Neonatal Intensive Care Unit Antibiotic Use

Molecular Detection of Late-Onset Neonatal Sepsis in Premature Infants Using Small Blood Volumes: Proof-of-Concept

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