Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. Across the state of California, there was greater than 100-fold variability in the number of infants treated with antibiotics per proven bloodstream infection, ranging from 7.3 to 781 infants treated.

2. The number of infants exposed to antibiotics correlated strongly with the number of live births admitted to the NICU though did not necessarily correlate with diagnostic efficiency.

Evidence Rating Level: 2 (Good)

Study Rundown:

Antibiotic use rates vary greatly across different in neonatal intensive care units (NICUs). This variability coupled with growing evidence that exposure to antibiotics early in life is associated with negative outcomes such as asthma, obesity, atopy, and inflammatory bowel disease has prompted the implementation of antibiotic stewardship initiatives. Though such efforts have been widespread, there is little to no standardization across NICUs for antibiotic use or sepsis screening. In this article, authors sought to determine the rate of antibiotic use among a number of California hospitals in comparison to their actual rate of diagnosed sepsis along with other variables. Researchers discovered a greater than 100-fold variability in the rate of antibiotic use per infant with confirmed bloodstream infection. Additionally, the number of infants treated with antibiotics correlated more with the number of live born infants admitted to the NICU than with the diagnostic efficacy of the screening protocol being used. This discrepancy demonstrates the need for standardization of antibiotic use in NICUs to support antibiotic stewardship.

In-Depth [retrospective cohort]:

Researchers used data from the California Perinatal Quality Care Collaborative, which draws from NICUs throughout the state of California. All infants at these institutions born during 2017 were included in the study data. Ultimately, 121 hospitals were included, totaling 326 845 live births. The percentage of infants exposed to antibiotics varied widely across the various institutions, with the 10th percentile being 3.67%, and the 90th being 14.4%. Across the state, 34.3 newborns were treated per confirmed bloodstream infection. Hospitals varied more than 100-fold in their rates of antibiotic use, treating anywhere from 7.3 to 781 infants per proven bloodstream infection (mean 66.4; SD 91.7; median 41.3). The percentage of newborns with antibiotic exposure correlated strongly with the rate of live born admissions at a given institution (r = 0.47; p = .0002), though rate of antibiotic exposure did not correlate with diagnostic efficacy.

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