Antibiotic Use in Neonatal Intensive Care Units in China: A Multicenter Cohort Study

Jiang, Siyuan; Zhang, Lan; Yan, Weili; Li, Shujuan; Han, Junyan; Zhou, Qi; Yang, Yi; Lee, Shoo K.; Cao, Yun; Ji, Yong Bae; Han, Sileny; Wang, Sannan; Li, Zhankui; Yang, Chuanzhong; Yang, Changyi; Xia, Shiwen; Chen, Ling; Shan, Ruobing; Liu, Ling; Yi, Bin; Lin, Zhenlang; Wang, Yang; Liu, Jiang-Qin; He, Ling; Li, Mingxia; Pan, Xinnian; Guo, Yan; Liu, Cuiqing; Zhou, Qin; Li, Xiaoying; Xiong, Hong; Qi, Yuan; Hei, Mingyan

doi:10.1016/j.jpeds.2021.08.067

Cited by 17 publications

(15 citation statements)

References 24 publications

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“…5 Department of Infectious Diseases/Venhalsan, Stockholm South General Hospital, Stockholm, Sweden. 6 Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao PDR. 7 Food and Drug Department, Ministry of Health, Vientiane, Lao PDR.…”

Section: Fundingmentioning

confidence: 99%

“…Antibiotics are frequently prescribed to children from the first days of their life. It was shown that more than 70% of newborns admitted to neonatal intensive care units receive antibiotics, with large variation across the world [ 5 , 6 ]. Previous European studies have shown high prevalence of antibiotic prescribing for children under six [ 7 ] with the highest proportion of antibiotic prescriptions for two year old children (29%) in comparison to other age categories [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic knowledge, attitudes and reported practice during pregnancy and six months after birth: a follow- up study in Lao PDR

Kounnavong

Yan

Sihavong

et al. 2022

BMC Pregnancy Childbirth

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Background Antibiotics are important medicines to prevent maternal and child morbidity and mortality. Women’s knowledge and attitudes towards antibiotic use influence their practice. When they become mothers, this may be mirrored in the use of antibiotics for their newborn children. The current study aimed to assess knowledge, attitudes, and reported practice of pregnant women regarding antibiotic use and antibiotic resistance as well as their approach towards antibiotic use for their newborn babies. Methods This was a follow-up study with data collected via structured interviews between September 2019 and August 2020 in Feuang (rural) and Vangvieng (urban) districts in Vientiane province, Lao PDR. We identified and invited all women attending antenatal care in their third trimester of pregnancy in the selected areas. Using a structured questionnaire at third trimester of pregnancy we captured data on knowledge regarding antibiotic use and resistance. We collected information on attitudes and reported practice at two time points: (i) at third trimester of pregnancy and (ii) 6 months after birth. Univariate analysis and frequency distributions were used to study pattern of responses. Chi-square and Mann-Whitney tests were used to compare categorical and continuous variables respectively. P value < 0.05 was considered statistically significant. Results We surveyed 539 women with a mean age of 25 years. Two oral antibiotics, i) ampicillin and ii) amoxicillin were correctly identified by 68 and 47% of participants respectively. Only 24% of women (19% in Feuang and 29% in Vangvieng) answered correctly that antibiotics are effective against bacterial infections. The most prevalent response was “I don’t know” suggesting the questions were challenging. Significantly less women would use antibiotics from a previous illness for their child than for themselves (16% vs 29%), however they would be more willing to use antibiotics for their baby even in case of mild symptoms (29% vs 17% while pregnant). The majority of antibiotics were prescribed by healthcare providers and 46% of children with the common cold received antibiotics. Conclusions Women’s knowledge was sub-optimal, still, they manifested appropriate attitudes towards antibiotic use during pregnancy and for their child. Nearly half of children received antibiotics for the common cold. There is a need for context adapted programs aiming at improving women’s knowledge, as well as healthcare providers, emphasising rational antibiotic prescribing during pregnancy and for children.

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Section: Fundingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antibiotic knowledge, attitudes and reported practice during pregnancy and six months after birth: a follow- up study in Lao PDR

Kounnavong

Yan

Sihavong

et al. 2022

BMC Pregnancy Childbirth

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“…Though various antibiotics stewardships have been developed to reduce antibiotics usage in neonates, it is still quite common in China to cover preterm neonates by empiric antibiotics in the first week of life 26,27 . The recent epidemiology study of antibiotics exposure in China showed that 88.4% of preterm infants with GA less than 34 weeks received antibiotics at the early stage of life, and the median duration of each antibiotic course was 9 days (interquartile range, 6–14 days) 28 . So far, no national‐level study has been done to reveal the empirical status of antibiotics exposure in China.…”

Section: Discussionmentioning

confidence: 99%

Dwell time and bloodstream infection incidence of umbilical venous catheterization in China

Zheng,

He,

Yang

et al. 2023

Pediatric Investigation

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ImportanceCentral line‐associated bloodstream infection (CLABSI) is one of the most serious complications of central venous access devices. Reducing the risk of CLABSI is of utmost significance in efforts to improve neonatal mortality rates and enhance long‐term prognosis.ObjectiveTo determine the dwell time and incidence of CLABSI of umbilical venous catheterization (UVC) for preterm infants in China.MethodsPreterm infants with UVC admitted to 44 tertiary neonatal intensive care units in 24 provinces in China were enrolled. Study period was from November 2019 to August 2021. The end point of observations was 48 h after umbilical venous (UV) catheter removal. The primary outcomes were dwell time of UV catheter and UVC‐associated CLABSI. Data between infants with UV catheter dwell time ≤7 days and >7 days, and with birth weight (BW) ≤1000 g and >1000 g were compared.ResultsIn total, 2172 neonates were enrolled (gestational age 30.0 ± 2.4 weeks, BW 1258.5 ± 392.8 g). The median UV catheter dwell time was 7 (6–10) days. The incidence of UVC‐associated CLABSI was 3.03/1000 UV catheter days. For infants with UV catheter dwell time ≤7 days and >7 days, the UVC‐associated CLABSI incidence was 3.71 and 2.65 per 1000 UV catheter days, respectively, P = 0.23. For infants with UVC dwell times of 3–6, 7–12, and 13–15 days, the UVC‐associated CLABSI rates were 0.14%, 0.68%, and 2.48% (P < 0.01). The Kaplan–Meier plot of UV catheter dwell time to CLABSI showed no difference between infants with BW ≤1000 g and >1000 g (P = 0.60).InterpretationThe median dwell time of UV catheter was 7 days, and the incidence of UVC‐associated CLABSI was 3.03/1000 catheter days in China. The daily risk of UVC‐associated CLABSI and other complications increased with the dwell time.

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“…Culture-negative sepsis was diagnosed when all the following criteria were fulfilled: 1) infection-related clinical manifestations; 2) abnormal white blood cell count, C-reactive protein level, or procalcitonin level; 3) antibiotics used or intended for ≥5 days; 4) negative blood culture; 5) no evidence of concurrent focal infection. 23 , 24 Early-onset sepsis was defined as sepsis diagnosed within 72 h of postnatal age. 25 Infants without UTI, necrotizing enterocolitis, or sepsis were defined as controls.…”

Section: Methodsmentioning

confidence: 99%

Pathogen-specific alterations in intestinal microbiota precede urinary tract infections in preterm infants: a longitudinal case-control study

Hong,

Huang,

Han

et al. 2024

Gut Microbes

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Urinary tract infections (UTIs) are among the most common late-onset infections in preterm infants, characterized by nonspecific symptoms and a pathogenic spectrum that diverges from that of term infants and older children, which present unique diagnostic and therapeutic challenges. Existing data on the role of gut microbiota in UTI pathogenesis in this demographic are limited. This study aims to investigate alterations in gut microbiota and fecal calprotectin levels and their association with the development of UTIs in hospitalized preterm infants. A longitudinal case-control study was conducted involving preterm infants admitted between January 2018 and October 2020. Fecal samples were collected weekly and analyzed for microbial profiles and calprotectin levels. Propensity score matching, accounting for key perinatal factors including age and antibiotic use, was utilized to match samples from UTI-diagnosed infants to those from non-UTI counterparts. Among the 151 preterm infants studied, 53 were diagnosed with a UTI, predominantly caused by Enterobacteriaceae (79.3%) and Enterococcaceae (19.0%). Infants with UTIs showed a significantly higher abundance of these families compared to non-UTI infants, for both Gram-negative and positive pathogens, respectively. Notably, there was a significant pre-UTI increase in the abundance of pathogen-specific taxa in infants later diagnosed with UTIs, offering high predictive value for early detection. Shotgun metagenomic sequencing further confirmed the dominance of specific pathogenic species pre-UTI and revealed altered virulence factor profiles associated with Klebsiella aerogenes and Escherichia coli infections. Additionally, a decline in fecal calprotectin levels was observed preceding UTI onset, particularly in cases involving Enterobacteriaceae. The observed pathogen-specific alterations in the gut microbiota preceding UTI onset offer novel insight into the UTI pathogenesis and promising early biomarkers for UTIs in preterm infants, potentially enhancing the timely management of this common infection. However, further validation in larger cohorts is essential to confirm these findings.

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Antibiotic Use in Neonatal Intensive Care Units in China: A Multicenter Cohort Study

Cited by 17 publications

References 24 publications

Antibiotic knowledge, attitudes and reported practice during pregnancy and six months after birth: a follow- up study in Lao PDR

Antibiotic knowledge, attitudes and reported practice during pregnancy and six months after birth: a follow- up study in Lao PDR

Dwell time and bloodstream infection incidence of umbilical venous catheterization in China

Pathogen-specific alterations in intestinal microbiota precede urinary tract infections in preterm infants: a longitudinal case-control study

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