Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-16T15:07:51.257Z Has data issue: false hasContentIssue false
  • English
  • Français

Antibiotic spectrum index: A new tool comparing antibiotic use in three NICUs

Published online by Cambridge University Press:  23 November 2021

Brynne A. Sullivan Open the ORCID record for Brynne A. Sullivan [Opens in a new window] ,
Aneesha Panda ,
Aaron Wallman-Stokes Open the ORCID record for Aaron Wallman-Stokes [Opens in a new window] ,
Rakesh Sahni ,
Karen D. Fairchild ,
Jason G. Newland ,
Christopher C. McPherson Open the ORCID record for Christopher C. McPherson [Opens in a new window]  and
Zachary A. Vesoulis Open the ORCID record for Zachary A. Vesoulis [Opens in a new window]
Brynne A. Sullivan*
Affiliation:
Division of Neonatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
Aneesha Panda
Affiliation:
Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
Aaron Wallman-Stokes
Affiliation:
Division of Neonatology, Department of Pediatrics, Larner College of Medicine at University of Vermont, Burlington, Vermont
Rakesh Sahni
Affiliation:
Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
Karen D. Fairchild
Affiliation:
Division of Neonatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
Jason G. Newland
Affiliation:
Division of Pediatric Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
Christopher C. McPherson
Affiliation:
Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
Zachary A. Vesoulis
Affiliation:
Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
*
Author for correspondence: Brynne A. Sullivan, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Antibiotics are widely used in very low-birth-weight infants (VLBW, <1500 g), and excess exposure, particularly to broad-spectrum antibiotics, is associated with significant morbidity. An antibiotic spectrum index (ASI) quantifies antibiotic exposure by relative antimicrobial activity, adding information to exposure measured by days of therapy (DOT). We compared ASI and DOT across multiple centers to evaluate differences in antibiotic exposures.

Methods:

We extracted data from patients admitted to 3 level-4 NICUs for 2 years at 2 sites and for 1 year at a third site. We calculated the ASI per antibiotic days and DOT per patient days for all admitted VLBW infants <32 weeks gestational age. Clinical variables were compared as percentages or as days per 1,000 patient days. We used Kruskal-Wallis tests to compare continuous variables across the 3 sites.

Results:

Demographics were similar for the 734 VLBW infants included. The site with the highest DOT per patient days had the lowest ASI per antibiotic days and the site with the highest mortality and infection rates had the highest ASI per antibiotic days. Antibiotic utilization varied by center, particularly for choice of broad-spectrum coverage, although the organisms causing infection were similar.

Conclusion:

An antibiotic spectrum index identified differences in prescribing practice patterns among 3 NICUs unique from those identified by standard antibiotic use metrics. Site differences in infection rates and unit practices or guidelines for prescribing antibiotics were reflected in the ASI. This comparison uncovered opportunities to improve antibiotic stewardship and demonstrates the utility of this metric for comparing antibiotic exposures among NICU populations.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 11 , November 2022 , pp. 1553 - 1557
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ting, JY, Synnes, A, Roberts, A, et al. Association between antibiotic use and neonatal mortality and morbidities in very low-birth-weight infants without culture-proven sepsis or necrotizing enterocolitis. JAMA Pediatr 2016;170:1181–1187.CrossRefGoogle ScholarPubMed
Ting, JY, Roberts, A, Sherlock, R, et al. Duration of initial empirical antibiotic therapy and outcomes in very low birth weight infants. Pediatrics 2019;143:e20182286.CrossRefGoogle ScholarPubMed
Bizzarro, MJ. Avoiding unnecessary antibiotic exposure in premature infants: understanding when (not) to start and when to stop. JAMA Netw Open 2018;1:e180165.CrossRefGoogle Scholar
Fajardo, C, Alshaikh, B, Harabor, A. Prolonged use of antibiotics after birth is associated with increased morbidity in preterm infants with negative cultures. J Matern Fetal Neonatal Med 2019;32:4060–4066.CrossRefGoogle ScholarPubMed
Gerber, JS, Hersh, AL, Kronman, MP, Newland, JG, Ross, RK, Metjian, TA. Development and application of an antibiotic spectrum index for benchmarking antibiotic selection patterns across hospitals. Infect Control Hosp Epidemiol 2017;38:993–997.CrossRefGoogle ScholarPubMed
Lahart, AC, McPherson, CC, Gerber, JS, Warner, BB, Lee, BR, Newland, JG. Application of an antibiotic spectrum index in the neonatal intensive care unit. Infect Control Hosp Epidemiol 2019;40:1181–1183.CrossRefGoogle ScholarPubMed
Flannery, DD, Ross, RK, Mukhopadhyay, S, Tribble, AC, Puopolo, KM, Gerber, JS. Temporal trends and center variation in early antibiotic use among premature infants. JAMA Netw Open 2018;1:e180164.CrossRefGoogle ScholarPubMed
Patel, SJ, Saiman, L. Antibiotic resistance in neonatal intensive care unit pathogens: mechanisms, clinical impact, and prevention including antibiotic stewardship. Clin Perinatol 2010;37:547–563.CrossRefGoogle ScholarPubMed
Gomez-Arango, LF, Barrett, HL, McIntyre, HD, Callaway, LK, Morrison, M, Dekker Nitert, M. Antibiotic treatment at delivery shapes the initial oral microbiome in neonates. Sci Rep 2017;7:43481.CrossRefGoogle ScholarPubMed
Dardas, M, Gill, SR, Grier, A, et al. The impact of postnatal antibiotics on the preterm intestinal microbiome. Pediatr Res 2014;76:150–158.CrossRefGoogle ScholarPubMed
Cantey, JB, Wozniak, PS, Pruszynski, JE, Sánchez, PJ. Reducing unnecessary antibiotic use in the neonatal intensive care unit (SCOUT): a prospective interrupted time-series study. Lancet Infect Dis 2016;16:1178–1184.CrossRefGoogle ScholarPubMed
Fleiss, N, Hooven, TA, Polin, RA. Can we back off using antibiotics in the NICU? Semin Fetal Neonatal Med 2021;26:101217.CrossRefGoogle ScholarPubMed
Kaufman, DA, Gurka, MJ, Hazen, KC, Boyle, R, Robinson, M, Grossman, LB. Patterns of fungal colonization in preterm infants weighing less than 1000 grams at birth. Pediatr Infect Dis J 2006;25:733–737.CrossRefGoogle ScholarPubMed
Swanson, JR, Gurka, MJ, Kaufman, DA. Risk factors for invasive fungal infection in premature infants: enhancing a targeted prevention approach. J Pediatric Infect Dis Soc 2014;3:49–56.CrossRefGoogle ScholarPubMed
Rubin, LG, Sánchez, PJ, Siegel, J, et al. Evaluation and treatment of neonates with suspected late-onset sepsis: a survey of neonatologists’ practices. Pediatrics 2002;110(4):e42.CrossRefGoogle ScholarPubMed
International Neonatal, N. The CRIB (clinical risk index for babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units. Lancet 1993;342:193–198.CrossRefGoogle Scholar
Polin, RA, Sahni, R. Newer experience with CPAP. Semin Neonatol 2002;7:379–389.CrossRefGoogle ScholarPubMed
CDC. 2019 National Healthcare Safety Network Antimicrobial Use Option Report. Atlanta, GA: U.S. Department of Health and Human Services, CDC. 2020. Available from: https://www.cdc.gov/nhsn/pdfs/datastat/2019-au-report-508.pdf Google Scholar
van Santen, KL, Edwards, JR, Webb, AK, et al. The standardized antimicrobial administration ratio: a new metric for measuring and comparing antibiotic use. Clin Infect Dis 2018;67:179–185.CrossRefGoogle ScholarPubMed
Flannery, DD, Brandsma, E, Saslow, J, Mackley, AB, Paul, DA, Aghai, ZH. Do infants in the neonatal intensive care unit diagnosed with urinary tract infection need a routine voiding cystourethrogram? J Matern Fetal Neonatal Med 2019;32:1749–1754.CrossRefGoogle Scholar
National Collaborating Centre for Women’s and Children’s Health (UK). Urinary tract infection in children: diagnosis, treatment and long-term management. London: RCOG Press; 2007.Google Scholar
Aviles-Otero, N, Ransom, M, Weitkamp, J, et al. Urinary tract infections in very low birthweight infants: a two-center analysis of microbiology, imaging, and heart rate characteristics. J Neonatal Perinatal Med 2020;CrossRefGoogle Scholar
Stoll, BJ, Hansen, N, Fanaroff, AA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110(2 Pt 1):285–291.Google ScholarPubMed
Mukhopadhyay, S, Puopolo, KM. Neonatal early-onset sepsis: epidemiology and risk assessment. Neoreviews 2015;16:e221–e230.CrossRefGoogle Scholar
Supplementary material: File

Sullivan et al. supplementary material

Table S1

Download Sullivan et al. supplementary material(File)
File 21.6 KB