California neonatal intensive care units have huge differences in their rates of antibiotic use, a new study has found. And when it comes to antibiotics for hospitalized babies, more is not better: The study found no connection between a NICU's rate of antibiotic use and several measures of how its young patients fared.
The research, spearheaded by the California Perinatal Quality Care Collaborative and published last last week in Pediatrics, analyzed data from 52,061 infants in 127 California NICUs. Rates of antibiotic use varied 40-fold across the NICUs studied, as news reports about the research have explained. The study looked for correlations between antibiotic use and each NICU's rate of proven infection, rate of a serious complication of prematurity called necrotizing enterocolitis, average length of hospital stay, surgical volume and rate of patient deaths. No links were found.
"Variation in antibiotic prescribing practice appears to hinge on variation in how practitioners frame, interpret and respond to clinical situations ultimately considered unproven infection," said lead author Joseph Schulman, MD, of the California Department of Health Care Services, in an email about the research. "There are tradeoffs between benefits and harms when treating suspected but unproven infection."
Overuse of antibiotics presents real risks for babies, according to an accompanying editorial (.pdf) in Pediatrics. In addition to the potential for development of antibiotic-resistant pathogens, new research on the human microbiome raises the possibility that antibiotics may alter colonization of the body with healthy bacteria, the editorial says, possibly increasing the risk of necrotizing enterocolitis and of childhood obesity.
Yet there's also no question that, for many babies, antibiotics are lifesaving. Researchers and clinicians now face the tricky task of figuring out when antibiotics can safely be reduced.
"More research is needed, but there are important things we can do right now," senior author and Stanford neonatologist Jeffrey Gould, MD, told me. For instance, preterm babies whose mothers have signs of chorioamnionitis (an infection of the membranes around the baby) "are solid candidates for antibiotic prescriptions, but should be promptly taken off of antibiotics when cultures are negative and they have no symptoms," he said.
As the editorial concludes, "there is great potential to substantially reduce both risk and cost for this vulnerable population through more judicious use of antibiotics."
Previously: Study finds gap in referring California's tiniest babies to follow-up care, Stanford-led study suggests changes to brain-scanning guidelines for preemies and Helping families navigate the NICU
Photo, which originally appeared in Stanford Medicine News, courtesy of Lucile Packard Children's Hospital Stanford