Joseph Schulman1, William E Benitz2, Jochen Profit2,3,4, Henry C Lee2,3,4, Grace Dueñas2,3,4, Mihoko V Bennett2,3,4, Maria A L Jocson5, Roy Schutzengel5, Jeffrey B Gould2,3,4. 1. California Department of Health Care Services, California Children's Services, Sacramento, California; joseph.schulman@dhcs.ca.gov. 2. NICU, Lucile Packard Children's Hospital, Stanford, California. 3. Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California; and. 4. California Perinatal Quality Care Collaborative, Stanford, California. 5. California Department of Health Care Services, California Children's Services, Sacramento, California.
Abstract
OBJECTIVES: To estimate the percentage of hospital births receiving antibiotics before being discharged from the hospital and efficiency diagnosing proven bloodstream infection. METHODS: We conducted a cross-sectional study of 326 845 live births in 2017, with a 69% sample of all California births involving 121 California hospitals with a NICU, of which 116 routinely served inborn neonates. Exposure included intravenous or intramuscular antibiotic administered anywhere in the hospital during inpatient stay associated with maternal delivery. The main outcomes were the percent of newborns with antibiotic exposure and counts of exposed newborns per proven bloodstream infection. Units of observation and analysis were the individual hospitals. Correlation analyses included infection rates, surgical case volume, NICU inborn admission rates, and mortality rates. RESULTS: The percent of newborns with antibiotic exposure varied from 1.6% to 42.5% (mean 8.5%; SD 6.3%; median 7.3%). Across hospitals, 11.4 to 335.7 infants received antibiotics per proven early-onset sepsis case (mean 95.1; SD 71.1; median 69.5), and 2 to 164 infants received antibiotics per proven late-onset sepsis case (mean 19.6; SD 24.0; median 12.2). The percent of newborns with antibiotic exposure correlated neither with proven bloodstream infection nor with the percent of patient-days entailing antibiotic exposure. CONCLUSIONS: The percent of newborns with antibiotic exposure varies widely and is unexplained by proven bloodstream infection. Identification of sepsis, particularly early onset, often is extremely inefficient. Knowledge of the numbers of newborns receiving antibiotics complements evaluations anchored in days of exposure because these are uncorrelated measures.
OBJECTIVES: To estimate the percentage of hospital births receiving antibiotics before being discharged from the hospital and efficiency diagnosing proven bloodstream infection. METHODS: We conducted a cross-sectional study of 326 845 live births in 2017, with a 69% sample of all California births involving 121 California hospitals with a NICU, of which 116 routinely served inborn neonates. Exposure included intravenous or intramuscular antibiotic administered anywhere in the hospital during inpatient stay associated with maternal delivery. The main outcomes were the percent of newborns with antibiotic exposure and counts of exposed newborns per proven bloodstream infection. Units of observation and analysis were the individual hospitals. Correlation analyses included infection rates, surgical case volume, NICU inborn admission rates, and mortality rates. RESULTS: The percent of newborns with antibiotic exposure varied from 1.6% to 42.5% (mean 8.5%; SD 6.3%; median 7.3%). Across hospitals, 11.4 to 335.7 infants received antibiotics per proven early-onset sepsis case (mean 95.1; SD 71.1; median 69.5), and 2 to 164 infants received antibiotics per proven late-onset sepsis case (mean 19.6; SD 24.0; median 12.2). The percent of newborns with antibiotic exposure correlated neither with proven bloodstream infection nor with the percent of patient-days entailing antibiotic exposure. CONCLUSIONS: The percent of newborns with antibiotic exposure varies widely and is unexplained by proven bloodstream infection. Identification of sepsis, particularly early onset, often is extremely inefficient. Knowledge of the numbers of newborns receiving antibiotics complements evaluations anchored in days of exposure because these are uncorrelated measures.
Authors: Pavel Prusakov; Debra A Goff; Phillip S Wozniak; Azraa Cassim; Catherine E A Scipion; Soledad Urzúa; Andrea Ronchi; Lingkong Zeng; Oluwaseun Ladipo-Ajayi; Noelia Aviles-Otero; Chisom R Udeigwe-Okeke; Rimma Melamed; Rita C Silveira; Cinzia Auriti; Claudia Beltrán-Arroyave; Elena Zamora-Flores; Maria Sanchez-Codez; Eric S Donkor; Satu Kekomäki; Nicoletta Mainini; Rosalba Vivas Trochez; Jamalyn Casey; Juan M Graus; Mallory Muller; Sara Singh; Yvette Loeffen; María Eulalia Tamayo Pérez; Gloria Isabel Ferreyra; Victoria Lima-Rogel; Barbara Perrone; Giannina Izquierdo; María Cernada; Sylvia Stoffella; Sebastian Okwuchukwu Ekenze; Concepción de Alba-Romero; Chryssoula Tzialla; Jennifer T Pham; Kenichiro Hosoi; Magdalena Cecilia Calero Consuegra; Pasqua Betta; O Alvaro Hoyos; Emmanuel Roilides; Gabriela Naranjo-Zuñiga; Makoto Oshiro; Victor Garay; Vito Mondì; Danila Mazzeo; James A Stahl; Joseph B Cantey; Juan Gonzalo Mesa Monsalve; Erik Normann; Lindsay C Landgrave; Ali Mazouri; Claudia Alarcón Avila; Fiammetta Piersigilli; Monica Trujillo; Sonya Kolman; Verónica Delgado; Veronica Guzman; Mohamed Abdellatif; Luis Monterrosa; Lucia Gabriella Tina; Khalid Yunis; Marco Antonio Belzu Rodriguez; Nicole Le Saux; Valentina Leonardi; Alessandro Porta; Giuseppe Latorre; Hidehiko Nakanishi; Michal Meir; Paolo Manzoni; Ximena Norero; Angela Hoyos; Diana Arias; Rubén García Sánchez; Alexandra K Medoro; Pablo J Sánchez Journal: EClinicalMedicine Date: 2021-01-29
Authors: Bo M van der Weijden; Niek B Achten; Jolita Bekhof; Esther E Evers; Mylène Berk; Arvid W A Kamps; Maarten Rijpert; Gavin W Ten Tusscher; Marlies A van Houten; Frans B Plötz Journal: Acta Paediatr Date: 2020-08-10 Impact factor: 2.299