Prospective Surveillance of Antibiotic Use in the Neonatal Intensive Care Unit: Results from the SCOUT Study.
Pediatr Infect Dis J. 2014 Sep 4;
Authors: Cantey JB, Wozniak PS, Sánchez PJ
BACKGROUND:: Prolonged or unnecessary antibiotic use is associated with adverse outcomes in neonates. Our objectives were to quantify all antibiotic use in a Level III NICU and to identify scenarios where their use could be reduced.
METHODS:: Surveillance and evaluation of all antibiotic use provided to every infant admitted to a Level III NICU from 10/3/11-11/30/12 was performed. Types of antibiotics, reasons for their initiation, discontinuation, and duration, as well as clinical, laboratory and outcome data were recorded. Antibiotic use was quantified by days of therapy (DOT) per 1000 patient-days (PD).
RESULTS:: 1607 infants were included. The total antibiotic use was 9165 DOT (343.2 DOT/1000 PD; 5.7 DOT/infant). 72% of infants received 1 (43%) or more (29%) courses of antibiotics. Gentamicin (46%), ampicillin (39%), and oxacillin (8%) were the most frequently used agents. 94% of antibiotic use (323 DOT/1000 PD) was empiric therapy for suspected infection. 63% (216.2 DOT/1000 PD) was discontinued at approximately 48 hours when cultures were sterile (68% >48 h, 32% ≤48 h). 26% of all antibiotic use (89.4 DOT/1000 PD) was therapy for ≥ 5 days despite sterile cultures; pneumonia (16%) and "culture-negative" sepsis (8%) were the major contributors. 5% (17.4 DOT/1000 PD) of antibiotic use was for culture-proven sepsis, 5% (16.6 DOT/1000 PD) was penicillin prophylaxis for group B Streptococcus, and 1% (3.5 DOT/1000 PD) was pre-procedural prophylaxis.
CONCLUSIONS:: Narrow-spectrum therapy accounted for >92% of antibiotic use and would not be monitored by most stewardship programs. Only 5% of antibiotic usage was due to culture-proven infection. Pneumonia and "culture-negative" sepsis were frequent reasons for prolonged therapy; further study of these conditions may allow reduction in treatment duration.
PMID: 25191849 [PubMed - as supplied by publisher]