Medical Professional Publications

Antibiotics for Presumed Early-onset Neonatal Sepsis Costly but Often Unnecessary

Columbus, OH — July 2017

Early-onset neonatal sepsis (EONS) occurs when sepsis is transmitted from mother to child either during labor or before birth due to maternal bacteremia and infection. It presents within 72 hours of birth and is a major contributor to neonatal morbidity and mortality.

Isolation of bacteria from a central body fluid is the standard diagnostic method, but the time required for culture varies from 2 to 7 days, too long for effective initiation of antibiotic therapy for positive cases. In light of this, current clinical guidelines assert that all newborns must receive empiric broad-spectrum antibiotics based on maternal risk factors and suspicion of sepsis.

A recent retrospective cohort study from physician-researchers at Nationwide Children’s Hospital found that antibiotic overtreatment of infants with unconfirmed EONS is common and costly.

“The problem of culture positive neonatal sepsis is real, but it’s rare. Many babies are given an antibiotic without the need for it because guidelines dictate that you give it to them if the mother has certain symptoms,” says Irina A. Buhimschi, MD, director of the Center for Perinatal Research in The Research Institute at Nationwide Children’s. “If there is any doubt that a baby is healthy, then treatment will be administered – and should be. But current guidelines say that any mother who had a fever should have her baby treated with antibiotics, and epidurals cause fever. So the baby ends up being treated for sepsis even though the baby has no symptoms.”

The team utilized data from the Pediatric Health Information System (PHIS) to obtain a large sample of neonatal intensive care unit admissions with antibiotic administration data. Short courses of antibiotics lasting 3 days or less were treated as empiric over-initiation of antibiotics in infants, as a short course is insufficient to treat sepsis. The data was also utilized to determine differences across hospitals in frequency and duration of antibiotic courses.

The authors found that almost 50 percent of newborns were unnecessarily given antibiotics, which can contribute to antibiotic resistance and put neonates at increased risk of necrotizing enterocolitis. Preterm infants, the demographic most vulnerable to adverse effects of antibiotics, had the longest median treatment duration.

PHIS also reports adjusted total costs of each discharge, which the team used to determine the cost of antibiotic overtreatment. The cost of admission of all infants born at or after 35 weeks who were unnecessarily admitted to the neonatal intensive care unit and given antibiotic treatment was almost $77 million after adjustment to 2013 dollars (since it was the end year of the seven-year span of the retrospective).

“The real problem is that there’s no good diagnostic to tell you who needs to be treated.” adds Dr. Buhimschi, also a professor of Pediatrics and Obstetrics/Gynecology at The Ohio State University College of Medicine.

“Our lab’s current work is trying to find biomarkers in the clinically relevant timeframe that can be used as an inexpensive point-of-care diagnostic. In low- and mid-income countries, babies die because real sepsis is not caught early enough. So ideally, we want an inexpensive, non-invasive diagnostic test available to everybody,” she says.

Reference:
Oliver EA, Reagan PB, Slaughter JL, Buhimschi CS, Buhimschi IA. Patterns of empiric antibiotic administration for presumed early-onset neonatal sepsis in neonatal intensive care units in the United States. American Journal of Perinatology. 2017 Jun; 34(7):640-647.

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