title: Patterns of Empiric Antibiotic Administration for Presumed Early-Onset Neonatal Sepsis in Neonatal Intensive Care Units in the United States.
abstract: ObjectiveTo evaluate current patterns in empiric antibiotic use for early-onset neonatal sepsis (EONS).Study DesignRetrospective population-based cohort study of newborns admitted on postnatal day 0 to 1 and discharged from NICUs participating in the Pediatric Health Information System (PHIS 2006-2013). Analyses included frequency of antibiotic initiation within 3 days of birth, duration of first course, and variation among hospitals.ResultsOf 158,907 newborns, 118,624 (74.7%) received antibiotics on or before postnatal day 3. Within 3 days of treatment, 49.4% (n= 58,610) were discharged home or remained hospitalized without antibiotics. There was marked interhospital variation in the proportion of infants receiving antibiotics (range: 52.3-90.9%, mean 77.9%, SD 11.0%) and in treatment days (range: 3.2-8.6, mean 5.3, SD 1.4). Facilities with higher number of newborns started on antibiotics had longer courses (r= 0.643,p< 0.001). The cost of admissions for infants born at ≥35 weeks started on antibiotics and discharged home after no more than 3 days of antibiotics was $76,692,713.ConclusionSite variation in antibiotic utilization suggests antibiotic overtreatment of infants with culture unconfirmed EONS is common and costly.
authors.affiliation: Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Oliver
authors.affiliation: Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Reagan
authors.affiliation: Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Slaughter
authors.affiliation: Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Catalin S
authors.initials: CS
authors.lastname: Buhimschi
authors.affiliation: Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Irina A
authors.initials: IA
authors.lastname: Buhimschi
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016208:Databases, Factual; D004334:Drug Administration Schedule; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D000069342:Medical Overuse / Q000191:economics*; D000071074:Neonatal Sepsis / Q000188:drug therapy* / Q000382:microbiology; D047928:Premature Birth; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents