Most antibiotic use in NICU occurs in suspected, not proven, infections
Surveillance of all antibiotic use in a level 3 neonatal ICU indicated the majority of antibiotic prescriptions were narrow-spectrum and would not be monitored by most stewardship programs.
“When used appropriately, antibiotics are life-saving, but their overuse in NICUs has been associated with an increased risk for infection due to multidrug-resistant organisms, invasive candidiasis, necrotizing enterocolitis, late-onset sepsis and even death,” study researcher Joseph B. Cantey, MD, of the University of Texas Southwestern Medical Center, and colleagues wrote. “For this reason, pediatrics infectious disease specialists and neonatologists have urged development of antibiotic stewardship programs aimed at reducing overall antibiotic consumption and curtailing their unnecessary use in NICUs.”
Cantey and colleagues conducted the Surveillance and Correction of Unnecessary Antibiotic Therapy (SCOUT) — a prospective and retrospective assessment of antibiotic use in a 90-bed neonatal ICU — in an effort to inform future antibiotic stewardship programs. During the 14-month prospective surveillance period, 1,607 infants were admitted to the unit, and 99.8% received at least one dose of antibiotics.
Ninety-four percent of antibiotic use was initiated as empiric therapy for suspected infections, at a rate of 323 days of therapy per 1,000 patient-days. Five percent of antibiotic therapy administered for suspected infections eventually were confirmed by positive cultures.
Prolonged (5 days or more) antibiotic therapy despite sterile cultures accounted for 26% of antibiotic use. Pneumonia (16%) and culture-negative sepsis (8%) were the most frequent reasons for prolonged therapy. Sixty-four percent of pneumonia and 69% of culture-negative sepsis cases were treated for at least 7 days.
“Only a small fraction of antibiotic use in the NICU was directed toward proven infection,” according to Cantey and colleagues.
Sepsis confirmed by positive culture, necrotizing enterocolitis, cellulitis and congenital infections accounted for less than 7% of antibiotic use, and pneumonia accounted for 16%.
“Stewardship efforts to minimize unnecessary therapy are needed urgently, but must be informed by appropriate prospective surveillance of antibiotic use. ‘Ruled-out’ sepsis evaluations, pneumonia and ‘culture-negative’ sepsis courses are high-yield targets for antibiotic stewardship interventions,” Cantey and colleagues concluded. “Focusing on timely discontinuation of therapy once infection is ruled out as well as evaluating the safe, minimum duration of therapy for common clinical scenarios will help to reduce antibiotic use in the NICU and avoid the adverse outcomes associated with their use.” – by Amanda Oldt
Disclosure: The study was supported by a Gerber Novice Researcher Award through the Gerber Foundation. The researchers report no other relevant financial disclosures.