Antibiotic use for presumed neonatally acquired infections far exceeds that for central line-associated blood stream infections: an exploratory critique

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.