Antibiotic Use in Very Low Birth Weight Neonates After an Antimicrobial Stewardship Program
Abstract
:1. Introduction
2. Results
2.1. Antibiotic Treatments According to Birth Weight
2.2. Neonates with A Low Risk of EOS
2.3. Neonatal Complications, Deaths and Reinstitution of Antibiotics
3. Discussion
4. Materials and Methods
4.1. Study Design
4.2. Exclusion Criteria
4.3. Data Collection
4.4. Data Relating to Antibiotic Therapies
4.5. Definitions
4.6. Statistical Analyses
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | Baseline (n = 111) | Intervention (n = 119) | p |
---|---|---|---|
Prenatal steroids, n (%) | 96 (86) | 107 (90) | 0.42 |
Maternal indication for delivery, n (%) | 28 (25) | 39 (33) | 0.48 |
Histological chorioamnionitis, n (%) | 29 (26) | 31 (26) | 0.99 |
Twin birth, n (%) | 28 (25) | 31 (26) | 0.99 |
Prolonged membrane rupture (≥ 18 h), n (%) | 29 (26) | 34 (29) | 0.79 |
Maternal fever during labor (> 38 °C), n (%) | 3 (3) | 6 (5) | 0.57 |
Intrapartum antibiotic prophylaxis, n (%) No Adequate Inadequate | 68 (61) 30 (27) 7 (6) | 55 (46) 48 (40) 10 (8) | 0.06 |
Mode of delivery, n (%) Vaginal CS in labor or with membrane rupture CS before labor and with intact membranes | 21 (19) 30 (27) 60 (54) | 25 (21) 25 (21) 69 (58) | 0.56 |
Male gender, n (%) | 61 (55) | 67 (56) | 0.94 |
Gestational age, weeks, median (IQR) | 29 (26–31) | 29 (26–31) | 0.88 |
Birth weight, g, median (IQR) | 1146 (857–1346) | 1109 (851–1398) | 0.85 |
Apgar score at the 5th minute, median (IQR) | 8 (7–9) | 8 (6–9) | 0.03 |
CRIB score, median (IQR) | 1 (1–4) | 1 (0–4) | 0.27 |
Median length of stay, days (IQR) | 47 (29–75) | 46 (28–71) | 0.99 |
First antibiotic treatment Total, n (%) † 48-h rule-out course, n (%) § Median duration, hours (IQR) | 82 (74) 3 (4) 168 (120–192) | 84 (71) 37 (44) 72 (48–72) | 0.68 <0.01 <0.01 |
Days of therapy Total Median (IQR) | 1738 12 (0–23) | 1357 5 (0–16) | <0.01 <0.01 |
Days of therapy/1000 patient-days | 302 | 215 | < 0.01 |
Variables | Birth Weight < 1000 g, Baseline(n = 44) | Birth Weight < 1000 g, Intervention (n = 51) | p | Birth Weight 1000–1500 g, Baseline (n = 67) | Birth Weight 1000–1500 g, Intervention (n = 68) | p |
---|---|---|---|---|---|---|
Median length of stay, days (IQR) | 73 (51–87) | 71 (21–96) | 0.86 | 37 (29–53) | 42 (28–56) | 0.76 |
First antibiotic treatment Total, n (%) 48-h rule-out course, n (%) § Median duration, hours (IQR) | 39 (89) 2 (5) 168 (126–192) | 46 (90) 16 (35) 72 (48–96) | 0.93 <0.01 <0.01 | 43 (64) 1 (2) 168 (126–192) | 38 (56) 21 (55) 48 (48–72) | 0.42 <0.01 <0.01 |
Days of therapy Total Median (IQR) | 1056 22 (12–36) | 893 11 (5–25) | 0.01 0.01 | 682 8 (0–15) | 454 3 (0–5) | 0.01 0.01 |
Days of therapy/1000 patient-days | 367 | 266 | <0.01 | 238 | 154 | <0.01 |
Early-onset sepsis, n (%) | 3 (7) | 3 (6) | 0.79 | 0 (0) | 1 (1) | 0.99 |
Late-onset sepsis, n (%) | 15 (34) | 13 (25) | 0.36 | 5 (7) | 4 (6) | 0.71 |
Culture-negative sepsis, n (%) | 15 (34) | 9 (18) | 0.07 | 9 (13) | 4 (6) | 0.14 |
Necrotizing enterocolitis, n (%) | 0 (0) | 3 (6) | 0.30 | 1 (1) | 1 (1) | 0.99 |
Reinstitution of an antibiotic treatment, n (%) | 16 (36) | 19 (37) | 0.93 | 10 (15) | 4 (6) | 0.08 |
Variables | Baseline (n = 26) | Intervention (n = 34) | p |
---|---|---|---|
Male gender, n (%) | 12 (46) | 18 (53) | 0.79 |
Gestational age, weeks, median (IQR) | 31 (29–32) | 30 (29–31) | 0.04 |
Birth weight, g, median (IQR) | 1320 (1076–1456) | 1220 (990–1445) | 0.32 |
Apgar score at the 5th min, median (IQR) | 9 (7–10) | 8 (7–9) | 0.05 |
CRIB score, median (IQR) | 1 (0–1) | 1 (0–4) | 0.60 |
Twins, n (%) | 4 (15) | 5 (15) | 0.77 |
Maternal fever in labor (> 38 °C), n (%) | 0 (0) | 1 (3) | 0.89 |
IAP, n (%) No Adequate Inadequate | 25 (96) 0 (0) 1 (4) | 27 (79) 6 (18) 1 (3) | 0.04 |
Prenatal steroids, n (%) | 22 (85) | 31 (91) | 0.43 |
Median length of stay, days (IQR) | 47 (38–57) | 46 (42–57) | 0.99 |
First antibiotic treatment Total, n (%) 48-h rule-out course, n (%) § Median duration, hours (IQR) § | 13 (50) 0 (0) 144 (96–168) | 16 (48) 14 (88) 72 (48–72) | 0.97 <0.01 <0.01 |
Days of therapy Total Median (IQR) | 233 2 (0–15) | 190 0 (0–6) | <0.01 <0.01 |
Days of therapy/1000 patient-days | 194 | 113 | <0.01 |
Variables | Baseline (n = 111) | Intervention (n = 119) | p |
---|---|---|---|
Early-onset sepsis, n (%) | 3 (3) | 4 (3) | 0.93 |
Late-onset sepsis, n (%) | 20 (18) | 17 (14) | 0.44 |
Culture-negative sepsis, n (%) | 24 (22) | 13 (11) | 0.04 |
Necrotizing enterocolitis, n (%) † | 1 (1) | 4 (3) | 0.20 |
Reinstitution of an antibiotic treatment, n (%) | 26 (23) | 23 (19) | 0.55 |
Reasons for the reinstitution of an antibiotic treatment, n (%) § Culture-proven sepsis Suspect of sepsis Surgical prophylaxis | 5 (19) 17 (65) 4 (15) | 7 (30) 14 (61) 2 (9) | 0.56 0.98 0.78 |
Total case fatalities, n (%) | 11 (10) | 17 (14) | 0.41 |
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Berardi, A.; Zinani, I.; Rossi, C.; Spaggiari, E.; D’Amico, V.; Toni, G.; Bedetti, L.; Lucaccioni, L.; Iughetti, L.; Lugli, L. Antibiotic Use in Very Low Birth Weight Neonates After an Antimicrobial Stewardship Program. Antibiotics 2021, 10, 411. https://doi.org/10.3390/antibiotics10040411
Berardi A, Zinani I, Rossi C, Spaggiari E, D’Amico V, Toni G, Bedetti L, Lucaccioni L, Iughetti L, Lugli L. Antibiotic Use in Very Low Birth Weight Neonates After an Antimicrobial Stewardship Program. Antibiotics. 2021; 10(4):411. https://doi.org/10.3390/antibiotics10040411
Chicago/Turabian StyleBerardi, Alberto, Isotta Zinani, Cecilia Rossi, Eugenio Spaggiari, Virginia D’Amico, Greta Toni, Luca Bedetti, Laura Lucaccioni, Lorenzo Iughetti, and Licia Lugli. 2021. "Antibiotic Use in Very Low Birth Weight Neonates After an Antimicrobial Stewardship Program" Antibiotics 10, no. 4: 411. https://doi.org/10.3390/antibiotics10040411