Early Antibiotic Exposure in French NICUs

Background: Little is known about pharmacoepidemiology of antibiotics in french NICUs.

Objective: A multicenter retrospective analysis of electronic prescriptions collected as part of a neonatal prescription benchmarking program (B-PEN).

Methods: The study focuses on antibiotic prescriptions in 25 NICUs (23 level 3) that use the same prescription software (Logipren com.) powered by a common reference formulary adaptable to local prescription protocols. All prescription data were collected in 2017 and were deidentified before export to a common data warehouse. The study only includes newborns admitted in the first 28 days of life.

Results:

Overall population

- Distribution by gestational age (GA) of the 12,212 newborns included is as follows: 22-26 weeks of amenorrhea (wks): 4.0%, 27-31 wks: 13.8%, 32-34 wks: 18.4%, 35-36 wks: 15.0%, ≥37 wks: 48.9%.

- The antibiotic exposure rate was 45.5% (95% CI: 44.6-46.4). The rate of first antibiotic exposure on D0-D1 (day0-day1) was 74.0%.

- Of the 4,110 newborns treated with antibiotics on D0-D1: 97.0% received aminoglycosides, 63.2% β-lactams (except cephalosporins 3G-4G), 57.3% C3G-C4G, 1.2% glycopeptides, 0.3% carbapenems and 1.6% another antibiotic.

- On D0-D1, 75.4% of the treated patients received simultaneously two antibiotics, 22.1% three or more and 2.5% a single one.

- The median of antibiotic exposure rates observed in each NICU sets at 43.9% (p25%=36.8; p75%=52.4).

In premature babies with GA 32 wks (n=2,168)

- 1,674 (77.2%) were exposed to antibiotics (95% CI: 75.4-79.0).

- 75.9% of treated patients were exposed on D0-D1.

- Of these, 97.7% received aminoglycosides, 84.0% cephalosporins 3G/4G, 42.1% β-lactams (except C3G-C4G), 1.3% glycopeptides, 0.7% carbapenems, 0.9% another antibiotic.

- The median duration of exposure of antibiotic treatment started on D0-D1 was 3 days (p25%=2, p75%=4).

Conclusion: Compared with other GAs, very preterm infants are overexposed to antibiotics.