Rakesh Rao1, Kyong-Soon Lee2, Isabella Zaniletti3, Toby D Yanowitz4, Robert DiGeronimo5, Maria L V Dizon6, Shannon E Hamrick7, Girija Natarajan8, Eric S Peeples9, Karna Murthy6, Amit M Mathur10, An Massaro11. 1. Pediatrics, Washington University School of Medicine, St. Louis, MO, USA. Rao_R@wustl.edu. 2. Pediatrics, Hospital for Sick Children, Toronto, ON, Canada. 3. Children's Hospitals Association, Columbia, MO, USA. 4. Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 5. Pediatrics/Neonatology, Seattle Children's Hospital/University of Washington, Seattle, WA, USA. 6. Pediatrics/Neonatology, Northwestern University, Chicago, IL, USA. 7. Pediatrics, Emory University, Atlanta, GA, USA. 8. Children's Hospital of Michigan, Detroit, MI, USA. 9. Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA. 10. Pediatrics, St Louis University, St louis, MO, USA. 11. Neonatology, Children's National Health Systems, Washington, DC, DC, USA.
Abstract
OBJECTIVE(S): Quantify antimicrobial therapy (AMT) use in newborns with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia (HIE/TH). STUDY DESIGN: Newborns with HIE/TH were identified from the Children's Hospital Neonatal Database (CHND). Early infection (onset ≤7 days of life) was defined as "confirmed" (culture proven) or "suspected infection" (culture negative but treated) and compared with a "no infection" group. RESULTS: 1501/1534 (97.8%) neonates received AMT. 36 (2.3%) had confirmed, 255 (16.6%) suspected, and 1243 (81.0%) had no infection. The median (IQR) AMT duration was 13 (8-21), 8 (7-10), and 3 (3-7) days for the three groups, respectively (p < 0.001). AMT duration of use varied significantly across centers, adjusted for covariates (OR 1.88, 95% CI: 1.43-2.46). CONCLUSION(S): Incidence of early confirmed infection in neonates with HIE/TH (23/1000) is significantly higher than reported rates of early onset sepsis in term and near term infants (0.5-1.0/1000 live births). Antimicrobial-stewardship opportunities exist in infants with negative cultures.
OBJECTIVE(S): Quantify antimicrobial therapy (AMT) use in newborns with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia (HIE/TH). STUDY DESIGN: Newborns with HIE/TH were identified from the Children's Hospital Neonatal Database (CHND). Early infection (onset ≤7 days of life) was defined as "confirmed" (culture proven) or "suspected infection" (culture negative but treated) and compared with a "no infection" group. RESULTS: 1501/1534 (97.8%) neonates received AMT. 36 (2.3%) had confirmed, 255 (16.6%) suspected, and 1243 (81.0%) had no infection. The median (IQR) AMT duration was 13 (8-21), 8 (7-10), and 3 (3-7) days for the three groups, respectively (p < 0.001). AMT duration of use varied significantly across centers, adjusted for covariates (OR 1.88, 95% CI: 1.43-2.46). CONCLUSION(S): Incidence of early confirmed infection in neonates with HIE/TH (23/1000) is significantly higher than reported rates of early onset sepsis in term and near term infants (0.5-1.0/1000 live births). Antimicrobial-stewardship opportunities exist in infants with negative cultures.