Antibiotic spectrum index: A new tool comparing antibiotic use in three NICUs

2021 ◽  
pp. 1-5
Author(s):  
Brynne A. Sullivan ◽  
Aneesha Panda ◽  
Aaron Wallman-Stokes ◽  
Rakesh Sahni ◽  
Karen D. Fairchild ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Practice Patterns ◽  
Very Low Birth Weight ◽  
Antibiotic Use ◽  
Continuous Variables ◽  
Infection Rates ◽  
Low Birth Weight Infants ◽  
Vlbw Infants ◽  
Days Of Therapy ◽  
Prescribing Practice

Abstract Background: Antibiotics are widely used in very low-birth-weight infants (VLBW, <1500 g), and excess exposure, particularly to broad-spectrum antibiotics, is associated with significant morbidity. An antibiotic spectrum index (ASI) quantifies antibiotic exposure by relative antimicrobial activity, adding information to exposure measured by days of therapy (DOT). We compared ASI and DOT across multiple centers to evaluate differences in antibiotic exposures. Methods: We extracted data from patients admitted to 3 level-4 NICUs for 2 years at 2 sites and for 1 year at a third site. We calculated the ASI per antibiotic days and DOT per patient days for all admitted VLBW infants <32 weeks gestational age. Clinical variables were compared as percentages or as days per 1,000 patient days. We used Kruskal-Wallis tests to compare continuous variables across the 3 sites. Results: Demographics were similar for the 734 VLBW infants included. The site with the highest DOT per patient days had the lowest ASI per antibiotic days and the site with the highest mortality and infection rates had the highest ASI per antibiotic days. Antibiotic utilization varied by center, particularly for choice of broad-spectrum coverage, although the organisms causing infection were similar. Conclusion: An antibiotic spectrum index identified differences in prescribing practice patterns among 3 NICUs unique from those identified by standard antibiotic use metrics. Site differences in infection rates and unit practices or guidelines for prescribing antibiotics were reflected in the ASI. This comparison uncovered opportunities to improve antibiotic stewardship and demonstrates the utility of this metric for comparing antibiotic exposures among NICU populations.

scholarly journals Antibiotic Exposure and Growth Patterns in Preterm, Very Low Birth Weight Infants

2020 ◽  
Author(s):  
Alaina K. Pyle ◽  
Joseph B. Cantey ◽  
L. Steven Brown ◽  
Roy Heyne ◽  
Phillip S. Wozniak ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Antibiotic Use ◽  
Antibiotic Exposure ◽  
Low Birth Weight Infants ◽  
Days Of Therapy ◽  
Z Scores

Abstract Background. Antibiotic exposure in term infants has been associated with later obesity. Premature, very-low-birth-weight (birth weight ≤1500 grams) infants in the neonatal intensive care unit frequently are exposed to antibiotics. Our hypothesis was that in preterm infants, there is a positive linear and dose-dependent relationship between antibiotic exposure and growth from birth through 12 months’ corrected age.Methods. Retrospective analysis of prospectively collected data of all antibiotic use among inborn, preterm (≤32 weeks’ gestation), very-low-birth-weight infants admitted to the neonatal intensive care unit at Parkland Memorial Hospital and followed in the Low Birth Weight Clinic at Children’s Medical Center, Dallas, TX. Antibiotic use was quantified by days of therapy which was compared with weight and length parameters at birth, 36 weeks’ postmenstrual age, and 2, 4, 6, and 12 months’ corrected age. The change in weight and length z-scores from birth to all subsequent age points was calculated. Stepwise multivariate regression analysis was performed for weight, length, and weight-for-length delta z-scores at each age point. Results. During the 18-month study, 161 infants received a median of 11 (IQR, 5.5-19.5) antibiotic days of therapy which was not associated with weight or length delta z-scores from birth through 12 months’ corrected age.Conclusion. Association of prolonged antibiotic use and neonatal morbidities and mortality may override the potential association with increased weight gain in the NICU and beyond.

scholarly journals Antibiotic exposure and growth patterns in preterm, very low birth weight infants

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Alaina K. Pyle ◽  
Joseph B. Cantey ◽  
L. Steven Brown ◽  
Roy J. Heyne ◽  
Phillip S. Wozniak ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Antibiotic Use ◽  
Antibiotic Exposure ◽  
Low Birth Weight Infants ◽  
Days Of Therapy ◽  
Z Scores

Abstract Background Antibiotic exposure in term infants has been associated with later obesity. Premature, very-low-birth-weight (birth weight ≤ 1500 g) infants in the neonatal intensive care unit frequently are exposed to antibiotics. Our hypothesis was that in preterm infants, there is a positive linear and dose-dependent relationship between antibiotic exposure and growth from birth through 12 months’ corrected age. Methods Retrospective analysis of prospectively collected data of all antibiotic use among inborn, preterm (≤32 weeks’ gestation), very-low-birth-weight infants admitted to the neonatal intensive care unit at Parkland Memorial Hospital and followed in the Low Birth Weight Clinic at Children’s Medical Center, Dallas, TX. Antibiotic use was quantified by days of therapy which was compared with weight and length parameters at birth, 36 weeks’ postmenstrual age, and 2, 4, 6, and 12 months’ corrected age. The change in weight and length z-scores from birth to all subsequent age points was calculated. Stepwise multivariate regression analysis was performed to determine predictors of weight, length, and weight-for-length delta z-scores from birth to each subsequent age point. Results During the 18-month study, 161 infants received a median of 11 (IQR, 5.5–19.5) antibiotic days of therapy which was not associated with weight or length delta z-scores from birth through 12 months’ corrected age. Conclusion Association of prolonged antibiotic use and neonatal morbidities and mortality may override the potential association with increased weight gain in the NICU and beyond.

Quantifying Empiric Antibiotic Use in US Children’s Hospitals

2021 ◽  
Author(s):  
Kathleen Chiotos ◽  
Lauren D’Arinzo ◽  
Eimear Kitt ◽  
Rachael Ross ◽  
Jeffrey S. Gerber
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Use ◽  
Level Variation ◽  
Hospital Level ◽  
Broad Spectrum Antibiotic ◽  
Children's Hospitals ◽  
Broad Spectrum Antibiotics ◽  
Children’S Hospitals ◽  
Days Of Therapy ◽  
Rule Out

OBJECTIVES Empirical broad-spectrum antibiotics are routinely administered for short durations to children with suspected bacteremia while awaiting blood culture results. Our aim for this study was to estimate the proportion of broad-spectrum antibiotic use accounted for by these “rule-outs.” METHODS The Pediatric Health Information System was used to identify children aged 3 months to 20 years hospitalized between July 2016 and June 2017 who received broad-spectrum antibiotics for suspected bacteremia. Using an electronic definition for a rule-out, we estimated the proportion of all broad-spectrum antibiotic days of therapy accounted for by this indication. Clinical and demographic characteristics, as well as antibiotic choice, are reported descriptively. RESULTS A total of 67 032 episodes of suspected bacteremia across 42 hospitals were identified. From these, 34 909 (52%) patients were classified as having received an antibiotic treatment course, and 32 123 patients (48%) underwent an antibiotic rule-out without a subsequent treatment course. Antibiotics prescribed for rule-outs accounted for 12% of all broad-spectrum antibiotic days of therapy. Third-generation cephalosporins and vancomycin were the most commonly prescribed antibiotics, and substantial hospital-level variation in vancomycin use was identified (range: 16%–58% of suspected bacteremia episodes). CONCLUSIONS Broad-spectrum intravenous antibiotic use for rule-out infections appears common across children’s hospitals, with substantial hospital-level variation in the use of vancomycin in particular. Antibiotic stewardship programs focused on intervening on antibiotics prescribed for longer durations may consider this novel opportunity to further standardize antibiotic regimens and reduce antibiotic exposure.

scholarly journals A Clinical Analysis of Physical and Neurological Development in very Low Birth Weight Infants with MEIR (Massage, Exercises, Intelligence training, and Rehabilitation training)

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Yonghong Deng ◽  
Shulian Wang ◽  
Zhaohui Liu ◽  
Qi Liao ◽  
Yan Zeng
Keyword(s):  
Growth And Development ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Clinical Analysis ◽  
Psychomotor Development ◽  
Control Group ◽  
Low Birth Weight Infants ◽  
Vlbw Infants ◽  
Development Index ◽  
Rehabilitation Training

Objective: This study aimed to investigate the application of MEIR (Massage, Exercises, Intelligence training, and Rehabilitation training) in Chinese VLBW infants and to observe its effects on infants’ growth and development. Methods: Clinical data of 92 VLBW infants who were treated at the neonatal intensive care unit (NICU) of Loudi Central Hospital were retrospectively analyzed. The patients were grouped as the MEIR group (n=47) and controls (n=45). Physical and neurodevelopment development were compared between the two groups. Results: There were differences in height and weight and head circumference between the two groups at all corrected ages (all P<0.05). Abnormal motions, reflexes, muscular tension, audio-visual reactions, and posture, and the total numbers of abnormalities of 3-, 6-, 9- and 12-corrected month-old infants in the MEIR group were lower than in the control group (all P<0.05). The mental development index and psychomotor development index of 6- and 12- corrected month infants in the MEIR group were higher than in the control group (all P<0.05). Conclusion: MEIR could improve the physical and neurological developments of VLBW infants, reduce the incidence of adverse events, and improve their growth and development.

Impact of Order-Set Modifications and Provider Education Following Guideline Updates on Broad-Spectrum Antibiotic Use in Patients Admitted With Community Acquired Pneumonia

2021 ◽  
pp. 001857872110557
Author(s):  
Jessica L. Colmerauer ◽  
Kristin E. Linder ◽  
Casey J. Dempsey ◽  
Joseph L. Kuti ◽  
David P. Nicolau ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Intervention Period ◽  
Provider Education ◽  
Broad Spectrum Antibiotic ◽  
Post Intervention ◽  
Post Intervention Period ◽  
Days Of Therapy ◽  
Order Set

Purpose: Following updates to the Infectious Diseases Society of America (IDSA) practice guidelines for the Diagnosis and Treatment of Adults with Community-acquired Pneumonia in 2019, Hartford HealthCare implemented changes to the community acquired pneumonia (CAP) order-set in August 2020 to reflect criteria for the prescribing of broad-spectrum antimicrobial therapy. The objective of the study was to evaluate changes in broad-spectrum antibiotic days of therapy (DOT) following these order-set updates with accompanying provider education. Methods: This was a multi-center, quasi-experimental, retrospective study of patients with a diagnosis of CAP from September 1, 2019 to October 31, 2019 (pre-intervention) and September 1, 2020 to October 31, 2020 (post-intervention). Patients were identified using ICD-10 codes (A48.1, J10.00-J18.9) indicating lower respiratory tract infection. Data collected included demographics, labs and vitals, radiographic, microbiological, and antibiotic data. The primary outcome was change in broad-spectrum antibiotic DOT, specifically anti-pseudomonal β-lactams and anti-MRSA antibiotics. Secondary outcomes included guideline-concordance of initial antibiotics, utilization of an order-set to prescribe antibiotics, and length of stay (LOS). Results: A total of 331 and 352 patients were included in the pre- and post-intervention cohorts, respectively. There were no differences in order-set usage (10% vs 11.3%, P = .642) between the pre- and post-intervention cohort, respectively. The overall duration of broad-spectrum therapy was a median of 2 days (IQR 0-8 days) in the pre-intervention period and 0 days (IQR 0-4 days) in the post-intervention period ( P < .001). Patients in whom the order-set was used in the post-intervention period were more likely to have guideline-concordant regimens ([36/40] 90% vs [190/312] 60.9%; P = .003). Hospital LOS was shorter in the post-intervention cohort (4.8 days [2.9-7.2 days] vs 5.3 days [IQR 3.5-8.5 days], P = .002). Conclusion: Implementation of an updated CAP order-set with accompanying provider education was associated with reduced use of broad-spectrum antibiotics. Opportunities to improve compliance and thus further increase guideline-concordant therapy require investigation.

Early Vital Sign Differences in Very Low Birth Weight Infants with Severe Intraventricular Hemorrhage

2021 ◽  
Author(s):  
Santina A. Zanelli ◽  
Maryam Abubakar ◽  
Robert Andris ◽  
Kavita Patwardhan ◽  
Karen D. Fairchild ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Vital Sign ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Cranial Ultrasound ◽  
Low Birth Weight Infants ◽  
Vlbw Infants ◽  
Arterial Blood

Objective Severe intraventricular hemorrhage (sIVH, grades 3 and 4) is a serious complication for very low birth weight (VLBW) infants and is often clinically silent requiring screening cranial ultrasound (cUS) for detection. Abnormal vital sign (VS) patterns might serve as biomarkers to identify risk or occurrence of sIVH. Study Design This retrospective study was conducted in VLBW infants admitted to two level-IV neonatal intensive care units (NICUs) between January 2009 and December 2018. Inclusion criteria were: birth weight <1.5 kg and gestational age (GA) <32 weeks, at least 12 hours of systemic oxygen saturation from pulse oximetry (SpO2) data over the first 24 hours and cUS imaging. Infants were categorized as early sIVH (sIVH identified in the first 48 hours), late sIVH (sIVH identified after 48 hours and normal imaging in the first 48 hours), and no IVH. Infants with grades 1 and 2 or unknown timing IVH were excluded. Mean heart rate (HR), SpO2, mean arterial blood pressure (MABP), number of episodes of bradycardia (HR < 100 bpm), and desaturation (SpO2 < 80%) were compared. Results A total of 639 infants (mean: 27 weeks' gestation) were included (567 no IVH, 34 early sIVH, and 37 late sIVH). In the first 48 hours, those with sIVH had significantly higher HR compared with those with no IVH. Infants with sIVH also had lower mean SpO2 and MABP and more desaturations <80%. No significant differences in VS patterns were identified in early versus late sIVH. Logistic regression identified higher HR and greater number of desaturations <80% as independently associated with sIVH. Conclusion VLBW infants who develop sIVH demonstrate VS differences with significantly lower SpO2 and higher mean HR over the first 48 hours after birth compared with VLBW infants with no IVH. Abnormalities in early VS patterns may be a useful biomarker for sIVH. Whether VS abnormalities predict or simply reflect sIVH remains to be determined. Key Points

scholarly journals Beneficial Effects of Probiotic Treatment on Gut Microbiota in Very Low Birth Weight Infants

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Yue-feng Li ◽  
Chuan-rui Zhu ◽  
Xue-lei Gong ◽  
Hui-ling Li ◽  
Li-kuan Xiong ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Gut Microbiota ◽  
Very Low Birth Weight ◽  
Secondary Outcome ◽  
Rrna Gene ◽  
Low Birth Weight Infants ◽  
Microbial Composition ◽  
Vlbw Infants ◽  
Probiotic Treatment

The very low birth weight (VLBW) infant is at great risk for marked dysbiosis of the gut microbiota. In the present study, a total of 36 VLBW infants were randomly divided into two groups, who were treated with combined probiotics and placebo, and 72 fecal specimens on days 14 and 28 of life were collected from them. Finally, 32 fecal specimens extracted from 16 preterm VLBW infants were qualified and analyzed using 16S rRNA gene sequencing. The primary outcome was to evaluate the change of gut microbiota in VLBW infants after combined probiotic supplement. The secondary outcome was to analyze the correlation gut microbial composition and levels of cytokines. We found that probiotic treatment, but not placebo, decreased the α-diversity of gut microbiota in VLBW infants. At the phylum level, probiotic treatment strongly increased the abundance of Firmicutes, whereas that of Proteobacteria was significantly reduced. At the family level, Streptococcaceae and Lactobacillaceae became prevalent after probiotic treatment, while the relative abundance of Enterobacteriaceae was reduced in the meantime. Most notably, significant correlations were observed between Lactobacillaceae abundance and serum cytokine levels. Further studies are required to shed more light on the characteristics of gut microbiota of VLBW neonates. And the modulation of microbiota should be considered to improve the survival rate of VLBW infants.

scholarly journals Application of an antibiotic spectrum index in the neonatal intensive care unit

2019 ◽  
Vol 40 (10) ◽  
pp. 1181-1183 ◽  
Author(s):  
Alexandra C. Lahart ◽  
Christopher C. McPherson ◽  
Jeffrey S. Gerber ◽  
Barbara B. Warner ◽  
Brian R. Lee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antimicrobial Stewardship ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Antimicrobial Use ◽  
Low Birth Weight Infants ◽  
Antimicrobial Spectrum ◽  
Days Of Therapy ◽  
The Impact

AbstractAntimicrobial stewardship programs typically use days of therapy to assess antimicrobial use. However, this metric does not account for the antimicrobial spectrum of activity. We applied an antibiotic spectrum index to a population of very-low-birth-weight infants to assess its utility to evaluate the impact of antimicrobial stewardship interventions.

scholarly journals Disparities in Health Care–Associated Infections in the NICU

2019 ◽  
Vol 37 (02) ◽  
pp. 166-173 ◽  
Author(s):  
Jessica Liu ◽  
Charlotte Sakarovitch ◽  
Krista Sigurdson ◽  
Henry C. Lee ◽  
Jochen Profit
Keyword(s):  
Health Care ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Quality Care ◽  
Population Based ◽  
Black Mothers ◽  
Infection Rates ◽  
Vlbw Infants ◽  
Race Ethnicity ◽  
Health Care Associated Infection

Objectives This study aimed to examine multilevel risk factors for health care–associated infection (HAI) among very low birth weight (VLBW) infants with a focus on race/ethnicity and its association with variation in infection across hospitals. Study Design This is a population-based cohort study of 20,692 VLBW infants born between 2011 and 2015 in the California Perinatal Quality Care Collaborative. Results Risk-adjusted infection rates varied widely across neonatal intensive care units (NICUs), ranging from 0 to 24.6% across 5 years. Although Hispanic infants had higher odds of HAI overall, race/ethnicity did not affect the variation in infection rates. Non-Hispanic black mothers were more likely to receive care in NICUs within the top tertile of infection risk. Yet, among NICUs in this tertile, infants across all races and ethnicities suffered similar high rates of infection. Conclusion Hispanic infants had higher odds of infection. We found significant variation in infection across NICUs, even after accounting for factors usually associated with infection.

Pre-discharge growth pattern of very low birth weight infants (VLBW): A 5 year single center experience

2020 ◽  
pp. 1-6
Author(s):  
S.H. Elbeely ◽  
M.A. AlQurashi
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Growth Pattern ◽  
Very Low Birth Weight ◽  
Single Center ◽  
Low Birth Weight Infants ◽  
Cross Sectional ◽  
Vlbw Infants ◽  
The Mean

BACKGROUND: Very low birth weight infants born prematurely are at greater risk for growth delays that lead to Ex-utero Growth Restriction (EUGR) during vulnerable periods of organ structural and functional development. There is considerable evidence that early growth failure has adverse effects on long term neurodevelopment in children which often persists into adulthood. METHODS: This is a single-center cross-sectional study on live newborn infants with birth weight ranges from 500 to 1500 grams (VLBW) and gestational age (GA) between 24–32 weeks who were admitted to NICU at KAMC-Jeddah over a 5 year period (2009–2013). This study aims to evaluate predischarge growth pattern of VLBW infants in terms of weight, head circumference (HC) and length and to identify important variables that have influenced such growth pattern. RESULTS: Of the 135 infants included in the final analysis, 68 (50.4%) were male and 67 (49.6%) were female and the mean gestational age was 28.83±2.064 weeks and the mean birth weight 1166.74±256 grams. Ninety-two infants (68%) had discharge weight at ≤10th percentile and forty four (32%) had their weight >10th percentile. HC was the lowest affected among the anthropometric measurements with 42% ≤10th percentile. In terms of linear growth, 62% had their length ≤10th percentile. Amongst infants born ≤750 grams, 71% and 70% had HC and height at ≤10th percentile respectively, at the time of discharge. BPD was significantly associated with EUGR (p = 0.026). CONCLUSIONS: This study demonstrates that almost 2/3rd of VLBW infants born at KAMC-Jeddah with birth weight ≤750 grams were discharged home with EUGR as demonstrated by their weight, length, and HC ≤10th percentile. BPD was found to be significantly associated with EUGR amongst post-natal factors influencing EUGR.

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