Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-19T14:48:03.410Z Has data issue: false hasContentIssue false
  • English
  • Français

Epidemiology of Antiobiotic Use in a Neonatal Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Silvia N.S. Fonseca ,
Richard A. Ehrenkranz  and
Robert S. Baltimore
Silvia N.S. Fonseca
Affiliation:
Division of infectious Diseases, Departments of Pediatrics and Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
Richard A. Ehrenkranz
Affiliation:
Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut
Robert S. Baltimore*
Affiliation:
Division of infectious Diseases, Departments of Pediatrics and Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
*
Department of Pediatrics, Yale University School of Medicine, Box 3333, New Haven, CT 06510
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine the incidence and pattern of antibiotic use in a neonatal intensive care unit (NICU).

Design:

Prospective study of a one-month NICU cohort. Investigators visited each subject, checking nursing notes, antibiotic flow sheets, and laboratory data at each daily visit.

Setting:

The NICU at Yale-New Haven Hospital, New Haven, Connecticut; a regional care, level 3 unit in a tertiary care medical center.

Patients:

All infants admitted to the NICU for one month (n = 63) who resided in the unit for ≥ 24 hours.

Results:

75% of the infants had antibiotic treatment begun in the first 48 hours of life. The highest rate of antibiotic treatment starts was in premature infants with birthweight less than 1,500 g, 92% of whom received antibiotics in the first 48 hours. In the subsequent days of life the incidence of starting antibiotic treatment was low and sporadic and the prevalence of antibiotic treatment by day of life showed a sharp decline between the third and fourth days of life. Five cross-sectional studies in the nursery showed point-prevalence rates of antibiotic use to be 27% to 43% of the whole NICU population, highest in the intensive care sector of the unit and in those <72 hours of age.

Conclusions:

The high incidence of antibiotic starts in this NICU was largely the result of universal treatment of premature infants beginning on the first day of life. The risk of infection in these infants is quite low; more information is needed concerning how to distinguish infants who do not require treatment. This study provides comparison data for NICUs compiling data on incidence and prevalence of antibiotic use and developing programs to limit antibiotic use.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 15 , Issue 3 , March 1994 , pp. 156 - 162
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

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

1. Dunham, EC. Septicemia in the newborn. Am J Dis Child 1933;45:229–253.Google Scholar
2. Baltimore, RS, Andiman, WA. Infectious diseases of the newborn. In: Warshaw, JB, Hobbins, JS, eds. Principles and Practice of Perinatal Medicine. Menlo Park, CA: Addison-Wesley Publishing Company Inc; 1983:309–341.Google Scholar
3. Bradley, JS. Neonatal infections. Pediatr Infect Dis 1985;4:315–320.CrossRefGoogle ScholarPubMed
4. Klein, JO, Remington, JS. Current concepts of infections of the fetus and newborn infant. In: Remington, JS, Klein, JO, eds. Infectious Diseases of the Fetus and Newborn Infant. 3rd ed. Philadelphia, PA: WB Saunders Co, 1990:1–16.Google Scholar
5. Maguire, GC, Nordin, J, Myers, MG, Koontz, FP Hierholzer, W, Nassif, E. Infections acquired by young infants. Am J Dis Child 1981;135:693–698.Google ScholarPubMed
6. Goldmann, DA, Durbin, WA Jr, Freeman, J. Nosocomial infections in a neonatal intensive care unit. J Infect Dis 1981;144:449–459.Google Scholar
7. Jarvis, WR. Epidemiology of nosocomial infections in pediatric patients. Pediatr Infect Dis J 1987:6:344–351.CrossRefGoogle ScholarPubMed
8. Kotloff, KL, Blackmon, LR, Tenney, JH, Rennels, MB, Morris, GJ. Nosocomial sepsis in the neonatal intensive care unit. South Med J 1989;82:699–704.Google Scholar
9. Gladstone, IM, Ehrenkranz, RA, Edberg, SC, Baltimore, RS. A ten-year review of neonatal sepsis and comparison with the previous fifty-year experience. Pediatr Infect Dis J 1990;9:819–825.CrossRefGoogle ScholarPubMed
10. McCracken, GH, Freii, BJ. Infectious diseases of the fetus and newborn. In: Feigin, RD, Cherry, JD, eds. Textbook of Pediatric Infectious Diseases. 2nd ed. Philadelohia. PA: WB Saunders Co, 1987:940–1107.Google Scholar
11. Lesko, SM, Epstein, ME Mitchell, AA. Recent patterns of drug use in newborn intensive care. J Pediatr 1990;116:985–990.CrossRefGoogle ScholarPubMed
12. Rotimi, VO, Duerden, BI. The development of the bacterial flora in normal neonates. J Med Microbiol 1980;14:51–62.CrossRefGoogle Scholar
13. Long, SS, Swenson, RM. Determinants of the developing oral flora in normal newborns. Abpl Environ Microbiol 1976:32:494–497.CrossRefGoogle ScholarPubMed
14. Sprunt, K, Leidy, G, Redman, W. Abnormal colonization of neonates in an intensive care unit: means of identifying neonates at risk of infection. Pediatr Res 1978:12:998–1002.Google Scholar
15. Goldmann, DA Bacterial colonization and infection in the neonate. Am J Med 1981;70:417–422.Google Scholar
16. Matfin, G. Ecological impact of antibiotics in neonatal units. Lancet 1989;II:509.CrossRefGoogle Scholar
17. Cook, LN, Davis, RS, Stover, BH. Outbreak of amikacin-resistant enterobacteriaceae in an intensive care nursery. Pediatrics 1980;65:264–268.Google Scholar
18. Markowitz, SM, Veazey, JM Jr, Macrina, FL, Mayhall, CG, Iamb, VA. Sequential outbreaks of infection due to Klebsiella pneumoniae in a neonatal intensive care unit: implication of a conjugative R plasmid. J Infect Dis 1980;142:106–112.Google Scholar
19. Newport, MT, John, JE Michel, YM, Levkoff, AH. Endemic Serratia marcescens infection in a neonatal intensive care nursery associated with gastrointestinal colonization. Pediatr Infect Dis 1985;4:160–167.Google Scholar
20. Modi, N, Damjanovic, V, Cooke, RWI. Outbreak of cephalosporin-resistant Enterobacter cloacae infection in a neonatal intensive care unit. Arch Dis Child 1987;62:148–151.Google Scholar
21. Pharmacy Budget Reports 1992-93, New Haven, CT: Yale-New Haven Hospital; 1993.Google Scholar
22. Hammerschlag, MR, Klein, JO, Herschel, M, Chen, FCJ, Fermin, R Pattems of use of antibiotics in two newborn nurseries. N Engl J Med 1977;296:1268–1269.CrossRefGoogle Scholar
23. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
24. Hierholzer, WJ Jr, Zervos, MJ. Nosocomial bacterial infections. In: Evans, AS, Brachman, PS, eds. Bacterial Infections of Humans: Epidemiology and Control. 2nd ed. Plenum Medical Book Co: 1991:467–497.Google Scholar
25. Philip, AGS, Hewitt, JR. Early diagnosis of neonatal sepsis. Pediatrics 1980;65:1036–1041.Google Scholar
26. Philip, AGS. Decreased use of antibiotics using a neonatal screening technique. J Pediatr 1981;98:795–799.CrossRefGoogle ScholarPubMed
27. Echols, RM, Kowalsky, SF The use of an antibiotic order form for antibiotic utilization review: influence on physicians' prescribing patterns. J Infect Dis 1984;150:803–807.CrossRefGoogle ScholarPubMed