8 - Factors influencing antibiotics use for suspected neonatal sepsis during birth hospitalization in United States.

Poster Number: 8
Publication Number: 8.337

Ramesh Vidavalur, Weill Cornell Medicine, Ithaca, NY, United States; Naveed Hussain, Connecticut Children's, Farmington, CT, United States

Background: Nationwide, practice variation exists in usage of empiric antibiotic therapy for suspected neonatal sepsis (SNS). Current evidence supports less aggressive management using a risk-based approach and clinical observation to minimize potential sequelae of antibiotic therapy. While previous studies demonstrated higher rates of GBS colonization and proven sepsis rates in Black maternal-infant dyads, the rates of antibiotic use (AU) for SNS among different races have not been evaluated.

Objective: To elucidate the relationship between race, gestational age (GA), sex, chorioamnionitis (CA), number of antenatal visits (ANV) and antibiotics exposure for SNS among newborns in United States.

Design/Methods: We analyzed 2016-2020 Centers for Disease Control and Prevention-WONDER natality linked data for the primary outcome of empiric antibiotics use for SNS by race, sex, GA, CA, ANV. Differences and trends in categorical variables were analyzed with the χ2 test. ANOVA was done adjusting for infant and maternal factors present at birth associated with antibiotic use, including: GA, race and CA. Statistical significance was set at p

Results: AU decreased with increasing GA at birth (Figure 1). Female newborns had lower AU rates (OR 0.82; 95%CI: 0.81, 0.83). Black neonates had higher AU rates (OR-1.33; 95%CI :1.32,1.34) compared to White newborns. Asians had lowest rates (OR-0.96; 95% CI: 0.95-0.97). There was a significant difference in mean AU rates by race (pConclusion(s): Among newborns, AU rates for SNS differ by race, sex, GA, ANV and presence of CA. Overall trend of decreasing antibiotic utilization was observed in last five years. We speculate that combined stratified risk-based algorithms with implementation of antibiotic stewardship programs might have contributed to significant reductions in antibiotic use. Further studies are warranted to understand interstate variability in management of SNS in United States.
Table 1.Trends of Antibiotics Use by Gestational Age.
Figure 2.Antibiotics Use by Antenatal Visits and Pairwise Comparisons by Race.