Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Division of Neonatology, Children's Hospital of Philadelphia/University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Pediatric Infect Dis Soc. 2021 Mar 26;10(2):97-103. doi: 10.1093/jpids/piaa022.
The antibiotic use rate (AUR) has emerged as a potential metric for neonatal antibiotic use, but reported center-level AURs are limited by differences in case mix. The objective of this study was to identify patient characteristics associated with AUR among a large cohort of preterm infants.
Retrospective observational study using the Optum Neonatal Database, including infants born from January 1, 2010 through November 30, 2016 with gestational age 23-34 weeks admitted to neonatal units across the United States. Exposures were patient-level characteristics including length of stay, gestational age, sex, race/ethnicity, bacterial sepsis, necrotizing enterocolitis, and survival status. The primary outcome was AUR, defined as days with ≥ 1 systemic antibiotic administered divided by length of stay. Descriptive statistics, univariable comparative analyses, and generalized linear models were utilized.
Of 17 910 eligible infants, 17 836 infants (99.6%) from 1090 centers were included. Median gestation was 32.9 (interquartile range [IQR], 30.3-34) weeks. Median length of stay was 25 (IQR, 15-46) days and varied by gestation. Overall median AUR was 0.13 (IQR, 0-0.26) and decreased over time. Gestational age, sex, and race/ethnicity were independently associated with AUR (P < .01). AUR and gestational age had an unexpected inverse parabolic relationship, which persisted when only surviving infants without bacterial sepsis or necrotizing enterocolitis were analyzed.
Neonatal AURs are influenced by patient-level characteristics besides infection and survival status, including gestational age, sex, and race/ethnicity. Neonatal antibiotic use metrics that account for patient-level characteristics as well as morbidity case mix may allow for more accurate comparisons and better inform neonatal antibiotic stewardship efforts.
抗生素使用率（AUR）已成为衡量新生儿抗生素使用的潜在指标，但报告的中心水平 AUR 受到病例组合差异的限制。本研究的目的是确定与早产婴儿大队列 AUR 相关的患者特征。
使用 Optum 新生儿数据库进行回顾性观察性研究，包括 2010 年 1 月 1 日至 2016 年 11 月 30 日期间出生的胎龄 23-34 周、在美国新生儿病房住院的婴儿。暴露因素包括患者的特征，包括住院时间、胎龄、性别、种族/民族、细菌性败血症、坏死性小肠结肠炎和生存状态。主要结局是 AUR，定义为接受至少 1 种全身抗生素治疗的天数除以住院时间。使用描述性统计、单变量比较分析和广义线性模型。
在 17910 名合格婴儿中，纳入了来自 1090 个中心的 17836 名婴儿（99.6%）。中位胎龄为 32.9（四分位距[IQR]，30.3-34）周。中位住院时间为 25（IQR，15-46）天，且随胎龄而变化。总体中位 AUR 为 0.13（IQR，0-0.26），且随时间而下降。胎龄、性别和种族/民族与 AUR 独立相关（P<0.01）。AUR 与胎龄呈意外的抛物线关系，当仅分析无细菌性败血症或坏死性小肠结肠炎的存活婴儿时，这种关系仍然存在。
除感染和生存状态外，新生儿 AUR 还受患者特征的影响，包括胎龄、性别和种族/民族。考虑到患者特征和发病率病例组合的新生儿抗生素使用指标可能允许更准确的比较，并更好地为新生儿抗生素管理工作提供信息。
