title: Antibiotic use for presumed neonatally acquired infections far exceeds that for central line-associated blood stream infections: an exploratory critique.
abstract: OBJECTIVE
  To assess antibiotic use as a complementary neonatal intensive care unit (NICU) infection measure to the central line-associated blood stream infection (CLABSI) rate.
  
  
  METHODS
  Patient days (PDs), line days, antibiotic (AB) use, CLABSI and other proven infections were analyzed in consecutive admissions to two NICUs over 3 and 6 months, respectively, from 1 January 2008 until discharge. An antibiotic course (AC) consisted of one or more uninterrupted antibiotic days (AD), classified as perinatal or neonatal, if started ≤3 d or ≥4 d post birth and as rule-out sepsis or presumed infection (PI) if treated ≤4 d or ≥5d, respectively. Events were expressed per 1000 PD and aggregated by conventional treatment categories and by clinical perception of infection certainty: possible, presumed or proven.
  
  
  RESULTS
  The cohort included 754 patients, 18,345 PD, 6637 line days, 718 AC and 4553 AD. Of total antibiotic use, neonatal use constituted 39.2% of ACs, and 29.0% of ADs, When analyzed per 1000 PD, antibiotic use to treat PIs vs CLABSIs, was either 14 fold (CI 6.6-30) higher for ACs (5.40 vs 0.38/1000 PD, P<0.0001) or 8.8 fold (CI 7.1-11) higher for ADs (48.3 vs 5.5/1000 PD, P<0.0001).
  
  
  CONCLUSIONS
  CLABSI rates, present a lower limit of NICU-acquired infections, whereas antibiotic-use measures, about 10-fold higher, may estimate an upper limit of that burden. Antibiotic-use metrics should be evaluated further for their ability to broaden NICU infection assessment and to guide prevention and antibiotic stewardship efforts.
authors.affiliation: David D Wirtschafter, MD, Inc., Valley Village, CA 91607, USA. david.wirtschafter@juno.com
authors.forename: D D
authors.initials: DD
authors.lastname: Wirtschafter
authors.forename: G
authors.initials: G
authors.lastname: Padilla
authors.forename: O
authors.initials: O
authors.lastname: Suh
authors.forename: K
authors.initials: K
authors.lastname: Wan
authors.forename: D
authors.initials: D
authors.lastname: Trupp
authors.forename: E E Simon
authors.initials: EE
authors.lastname: Fayard
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology* / Q000517:prevention & control; D004363:Drug Utilization; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care
chemical_list: D000900:Anti-Bacterial Agents