Short-course empiric antibiotic therapy for possible early-onset sepsis in the NICU

Sánchez, Pablo J.; Prusakov, Pavel; Romero, Concepción de Alba; Zamora-Flores, Elena; Escamilla, María Camila Reyes; White, Natalie; Miller, Randy; Moraille, Richard; Theile, Anthony R; Magers, Jacqueline

doi:10.1038/s41372-023-01634-3

Cited by 11 publications

(5 citation statements)

References 29 publications

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“…They are followed by clinical examinations, and antibiotic treatment is started only if symptoms of sepsis develop. Antimicrobial stewardship programs aimed at safely reducing administration of unwarranted antibiotic treatment and encouraging safe discontinuation of antibiotics within 36 to 48 hours have also been reported …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Antimicrobial stewardship programs aimed at safely reducing administration of unwarranted antibiotic treatment and encouraging safe discontinuation of antibiotics within 36 to 48 hours have also been reported. 41,44,45 This study presents nationwide population-based data on antibiotic use over time and by level of care in Sweden. In future studies, we plan to explore further the regional variation in antibiotic use and the numbers and proportions of culture-negative sepsis.…”

Section: Level I Level Ii Level Iii Swedenmentioning

confidence: 99%

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Antibiotic Use in Late Preterm and Full-Term Newborns

Gyllensvärd,

Studahl,

Gustavsson

et al. 2024

JAMA Netw Open

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ImportanceAntibiotic treatment saves lives in newborns with early-onset sepsis (EOS), but unwarranted antibiotic use is associated with resistant bacteria and adverse outcomes later in life. Surveillance is needed to optimize treatment strategies.ObjectiveTo describe antibiotic use in association with the incidence and mortality from EOS among late-preterm and full-term newborns.Design, Setting, and ParticipantsThe Sweden Neonatal Antibiotic Use study was a nationwide observational study that included all late-preterm and full-term neonates born from January 1, 2012, to December 31, 2020, in neonatal units of all levels. All hospital live births from 34 weeks’ gestation during the study period were included in the study. Data were collected from the Swedish Neonatal Quality Register and the Swedish Medical Birth Register. Data were analyzed from August 2022 to May 2023.ExposureAdmission for neonatal intensive care during the first week of life.Main Outcomes and MeasuresThe main outcomes were the usage of intravenous antibiotics during the first week of life, the duration of antibiotic therapy, the rate of culture-proven EOS, and mortality associated with EOS.ResultsA total of 1 025 515 newborns were included in the study; 19 286 neonates (1.88%; 7686 girls [39.9%]; median [IQR] gestational age, 40 [38-41] weeks; median [IQR] birth weight, 3610 [3140-4030] g) received antibiotics during the first week of life, of whom 647 (3.4%) had EOS. The median (IQR) duration of antibiotic treatment in newborns without EOS was 5 (3-7) days, and there were 113 antibiotic-days per 1000 live births. During the study period there was no significant change in the exposure to neonatal antibiotics or antibiotic-days per 1000 live births. The incidence of EOS was 0.63 per 1000 live births, with a significant decrease from 0.74 in 2012 to 0.34 in 2020. Mortality associated with EOS was 1.39% (9 of 647 newborns) and did not change significantly over time. For each newborn with EOS, antibiotic treatment was initiated in 29 newborns and 173 antibiotic-days were dispensed.Conclusions and RelevanceThis large nationwide study found that a relatively low exposure to antibiotics is not associated with an increased risk of EOS or associated mortality. Still, future efforts to reduce unwarranted neonatal antibiotic use are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Level I Level Ii Level Iii Swedenmentioning

confidence: 99%

See 1 more Smart Citation

Antibiotic Use in Late Preterm and Full-Term Newborns

Gyllensvärd,

Studahl,

Gustavsson

et al. 2024

JAMA Netw Open

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“…Our approach is similar to the one reported recently by Sanchez et al for treating EOS. 32 We based our decision to discontinue antibiotics earlier on our initial retrospective blood culture analysis that all the organisms involved in EOS became culture-positive in less than 24 hours. The study by Marks et al found that all but one of their positive blood cultures in EOS became positive within 24 hours.…”

Section: Discussionmentioning

confidence: 99%

New strategies to Reduce Unnecessary Antibiotic Use in the NICU: A Quality Improvement Initiative

Pantoja,

Sveum,

Frost

et al. 2023

Pediatric Quality &Amp; Safety

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Introduction: Early-onset sepsis (EOS) and late-onset Sepsis (LOS) are common diagnoses entertained in sick newborns treated in neonatal intensive care units (NICUs), and antibiotics are the medications most prescribed in NICUs. Antibiotic stewardship programs have an important impact on limiting unnecessary antibiotic use. Methods: Following the Model for Improvement, between 2/1/16 and 1/31/17, at a level 3 NICU, a multidisciplinary team implemented PDSA cycles to promote antibiotic stewardship practices for newborns at risk of EOS and LOS. The main goal was to decrease the antibiotic usage rate (AUR) safely. Primary strategies included discontinuing antibiotics within 24 hours of life if the newborn was stable, and the blood culture was negative for EOS and implementing an “antibiotic time-out” during rounds. Results: For all newborns admitted to our NICU, the AUR decreased, for EOS from 137 to 32 days per 1000 patient days (77% reduction) and for LOS from 277 to 121 days per 1000 patient days (56% reduction). We demonstrated the sustainability of both EOS-AUR and LOS-AUR during the 2 years postcompletion of the intervention period. There were no adverse effects of reducing the AUR. Conclusion: Interventions that reduce unnecessary antibiotic use in the NICU are safe and prevent excessive antibiotic exposure.

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“…In the most recent issue of the Journal of Perinatology, Sanchez et al report their results of a retrospective review assessing duration of empiric antibiotic use in 414 newborns undergoing an early onset sepsis (EOS) evaluation [1]. 24-hour and 48-hour empiric antibiotic courses were compared for safety endpoints including mortality and re-initiation of antibiotics within 7 days of discontinuation.…”

Section: To the Editormentioning

confidence: 99%