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Antibiotic use for presumed neonatally acquired infections far exceeds that for central line-associated blood stream infections: an exploratory critique

Journal of Perinatology volume 31, pages 514–518 (2011)Cite this article

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Abstract

Objective:

To assess antibiotic use as a complementary neonatal intensive care unit (NICU) infection measure to the central line-associated blood stream infection (CLABSI) rate.

Study Design:

Patient days (PDs), line days, antibiotic (AB) use, CLABSI and other proven infections were analyzed in consecutive admissions to two NICUs over 3 and 6 months, respectively, from 1 January 2008 until discharge. An antibiotic course (AC) consisted of one or more uninterrupted antibiotic days (AD), classified as perinatal or neonatal, if started ⩽3 d or ⩾4 d post birth and as rule-out sepsis or presumed infection (PI) if treated ⩽4 d or ⩾5d, respectively. Events were expressed per 1000 PD and aggregated by conventional treatment categories and by clinical perception of infection certainty: possible, presumed or proven.

Result:

The cohort included 754 patients, 18 345 PD, 6637 line days, 718 AC and 4553 AD. Of total antibiotic use, neonatal use constituted 39.2% of ACs, and 29.0% of ADs, When analyzed per 1000 PD, antibiotic use to treat PIs vs CLABSIs, was either 14 fold (CI 6.6–30) higher for ACs (5.40 vs 0.38/1000 PD, P<0.0001) or 8.8 fold (CI 7.1–11) higher for ADs (48.3 vs 5.5/1000 PD, P<0.0001).

Conclusion:

CLABSI rates, present a lower limit of NICU-acquired infections, whereas antibiotic-use measures, about 10-fold higher, may estimate an upper limit of that burden. Antibiotic-use metrics should be evaluated further for their ability to broaden NICU infection assessment and to guide prevention and antibiotic stewardship efforts.

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Author information

Authors and Affiliations

  1. David D Wirtschafter, MD, Inc., Valley Village, CA, USA

    D D Wirtschafter

  2. Miller Children's Hospital Long Beach, Long Beach, CA, USA

    G Padilla & O Suh

  3. Loma Linda Medical Center, Loma Linda, CA, USA

    K Wan, D Trupp & E E Simon Fayard

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  1. D D Wirtschafter
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Correspondence to D D Wirtschafter.

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Wirtschafter, D., Padilla, G., Suh, O. et al. Antibiotic use for presumed neonatally acquired infections far exceeds that for central line-associated blood stream infections: an exploratory critique. J Perinatol 31, 514–518 (2011). https://doi.org/10.1038/jp.2011.39

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