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Am J Perinatol 2017; 34(07): 640-647
DOI: 10.1055/s-0036-1596055
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Patterns of Empiric Antibiotic Administration for Presumed Early-Onset Neonatal Sepsis in Neonatal Intensive Care Units in the United States

Emily A. Oliver
1   Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
2   Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
,
Patricia B. Reagan
1   Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
3   Department of Economics, The Ohio State University, Columbus, Ohio
4   Center for Human Resource Research, The Ohio State University, Columbus, Ohio
,
Jonathan L. Slaughter
1   Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
5   Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
,
Catalin S. Buhimschi
1   Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
2   Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
,
Irina A. Buhimschi
1   Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
2   Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
5   Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
› Author Affiliations
Further Information

Publication History

06 June 2016

24 October 2016

Publication Date:
06 December 2016 (online)

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Abstract

Objective To evaluate current patterns in empiric antibiotic use for early-onset neonatal sepsis (EONS).

Study Design Retrospective population-based cohort study of newborns admitted on postnatal day 0 to 1 and discharged from NICUs participating in the Pediatric Health Information System (PHIS 2006–2013). Analyses included frequency of antibiotic initiation within 3 days of birth, duration of first course, and variation among hospitals.

Results Of 158,907 newborns, 118,624 (74.7%) received antibiotics on or before postnatal day 3. Within 3 days of treatment, 49.4% (n = 58,610) were discharged home or remained hospitalized without antibiotics. There was marked interhospital variation in the proportion of infants receiving antibiotics (range: 52.3–90.9%, mean 77.9%, SD 11.0%) and in treatment days (range: 3.2–8.6, mean 5.3, SD 1.4). Facilities with higher number of newborns started on antibiotics had longer courses (r = 0.643, p < 0.001). The cost of admissions for infants born at ≥35 weeks started on antibiotics and discharged home after no more than 3 days of antibiotics was $76,692,713.

Conclusion Site variation in antibiotic utilization suggests antibiotic overtreatment of infants with culture unconfirmed EONS is common and costly.

Keywords

chorioamnionitis - neonatal sepsis - group B Streptococcus - preterm birth
 

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