A new study has concluded that antibiotic use varies by almost 95 percent in different neonatal intensive care units.

A study published today in the American Academy of Pediatrics journal has concluded that antibiotic use to treat suspected infection in neonatal intensive care units (NICUs) varies greatly from place to place.

Antibiotics are used to fight bacterial infections and can vary in intensity based on type. Because it’s important to monitor use of any sort of medication in newborns, researchers from California decided to look into how intensive care units use antibiotics in our youngest humans.

This was the largest study of its kind, examining care at 127 NICUs for 52,061 infants who spent a total of 746,051 days in the hospital. While researchers had expected some variation in antibiotic use, they said they were surprised by the extent to which antibiotic use differed.

They reported the use of antibiotics varied from 2.4 percent to 97 percent of patient-days with the median being about 24 percent.

“The 40-fold variation was much greater than expected or previously reported,” said study co-author Dr. Joseph Schulman, the director of NICU Quality Measurement and Improvement for California Children’s Services. “Perhaps even more surprising, there was no correlation between reported burden of proven infection and the rate of antibiotic use.” 

That means, he said, that for approximately the same amount of infection, antibiotic use varied depending on location.

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On one hand, the risk of serious illness or death from untreated infection in newborns is high and negative culture results cannot completely rule out infection. However, these findings indicate the threshold level for unproven but suspected infection can be raised for starting or continuing antibiotics, Schulman said. 

The variation appears to be explained by how practitioners in NICUs interpret and respond to situations concerning unproven infection.

“At the core, the practice variation stems from inability to diagnose infection in neonates with perfect accuracy,” Dr. Schulman said. 

These findings may result in the narrowing of the range of antibiotic use in NICUs. Antibiotic use in newborns has been associated with increased risk of hospital-acquired infection, mortality, asthma later in life, altered balance of the microbes that colonize every person’s intestinal tract, as well as a serious neonatal inflammatory bowel condition called necrotizing enterocolitis, Schulman said. 

Antibiotics treat infection by attacking invading microbes. However, they also kill good microbes and the eradication can lead to digestive problems or imbalance in the body.

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Antibiotic use can also lead to antibiotic resistance, so overuse early in life can have a negative impact later on. 

“Antibiotic use is also associated with the selection of disease-causing microbes that are resistant to multiple antibiotics,” Schulman said.

These so-called multi-drug resistant pathogens are associated with increased morbidity, mortality, cost of care, and length of hospital stay. 

“There are tradeoffs between benefits and harms when treating suspected but unproven infection. These benefits and harms may vary among different neonates and these considerations need to be quantified,” Schulman said.

Moving forward, Schulman said it’s important that organizations track antibiotic use and see if it’s possible to streamline treatments.

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