There are significant gaps between the recommendations issued by the Centers for Disease Control and Prevention (CDC) to improve antibiotic stewardship, which may have resulted in significant differences in clinical practice in neonatal settings, according to study findings published in Pediatrics.

 In infants requiring intensive care, antibiotics are the most commonly prescribed medications, but estimates show that anywhere from 20% to 50% of the antibiotics prescribed in newborn intensive care units (NICU) are inappropriate. In this study, the variability of NICU antibiotic use rates were assessed at 143 centers with a total cohort of 4127 infants. Unit measures used in this study were developed from the 7 domains of the CDC’s Core Elements of Hospital Antibiotic Stewardship Programs: leadership commitment, accountability, drug expertise, action, tracking, reporting, and education.

None of the facilities addressed all 7 core elements, and only accountability (55%) and drug expertise (62%), showed compliance higher than 50% at these facilities. A total of 725 infants received antibiotics, 632 (87%) of whom had blood cultures that were obtained prior to beginning therapy. Only 15% of participants had urine cultures and 8% had cerebrospinal fluid cultures drawn before initiating antibiotics. Of importance, of the 412 patients who were on >48 hours of antibiotics, only 26% (n=107) had positive culture results, 17% had no culture drawn, and 69% had at least one negative culture. With regard to indication for antibiotic initiation, 35% of patients received them because of maternal risk factors and 44% because of suspected early onset sepsis.

The researchers noted that “the significant majority of patients who were on antibiotics for >48 hours despite the absence of positive culture results highlights some potential for improvement in antibiotic overuse.”

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Reference

Ho T, Buus-Frank ME, Edwards EM, et al. Adherence of newborn-specific antibiotic stewardship programs to CDC recommendations [published online December 1, 2018]. Pediatrics. doi:10.1542/peds.2017-4322