Document Detail


Antibiotic use for presumed neonatally acquired infections far exceeds that for central line-associated blood stream infections: an exploratory critique.
MedLine Citation:
PMID:  21546938     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.Study Design: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.Result: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).Conclusion: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.Journal of Perinatology advance online publication, 5 May 2011; doi:10.1038/jp.2011.39.
Authors:
D D Wirtschafter; G Padilla; O Suh; K Wan; D Trupp; E E Simon Fayard
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-05
Journal Detail:
Title:  Journal of perinatology : official journal of the California Perinatal Association     Volume:  -     ISSN:  1476-5543     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8501884     Medline TA:  J Perinatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
David D Wirtschafter, MD, Inc., Valley Village, CA, USA.
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