6543 Review of routine antibiotic treatment for preterm babies with low risk of early-onset sepsis at a level 3 neonatal intensive care unit

Objectives Early and prolonged use of antibiotic therapy in preterm babies has been associated with adverse outcomes including increased incidence of necrotizing enterocolitis (NEC), bronchopulmonary dysplasia, and death.¹–³ Efforts have been made to reduce the use of antibiotics for preterm babies at low risk of early onset sepsis (EOS).⁴–⁶ We reviewed the use of antibiotics in preterm babies admitted to a level 3 neonatal unit who had low risk for developing EOS. The aim was to establish whether a change in practice would be feasible and safe in order to reduce routine use of antibiotics for this group, and to reduce the complications associated with early and prolonged antibiotic use. Methods We retrospectively reviewed notes for preterm babies born via caesarean section in our hospital in a 7-month period and identified those who had no risk factors for infection at time of delivery (i.e. born to women not in labour, no prolonged rupture of membranes, no suspicion of chorioamnionitis, no group-B-streptococcus colonisation). For these babies we recorded whether antibiotics were started, the results of the initial partial septic screen, the duration of antibiotics, and the subsequent incidence of late onset sepsis (LOS), NEC, and colonisation with resistant bacteria. Results Of the 49 babies we identified as having a low risk for EOS, 94% (46) received antibiotics. There was a single positive blood culture in this group, believed to be a contaminant. 78% (36) of those who commenced antibiotics stopped treatment after 36 hours. In those who received a prolonged course of antibiotics (greater than 36 hours), 8 continued due to raised C-reactive protein (CRP) without being unwell, 1 continued due to clinical concern, and 1 continued for unclear reasons. 54% (25) of the babies reviewed were subsequently treated for LOS during admission and 15% (7) of the babies were treated for NEC. 11% (5) developed colonization with antibiotic resistant organisms and 4 out of 5 of these had received a prolonged course of antibiotics for EOS. Conclusion Our results indicate that there is scope to reduce the number of babies at low risk of EOS who are treated with antibiotics on our unit. The majority of these babies receive antibiotics by default and are not subsequently found to be unwell, even when a rise in CRP level is noted. These findings may help to support a change in practice in our unit to improve antimicrobial stewardship. References Vatne A, et al. J Pediatr 2023 Feb;253:107–114.e5. doi: 10.1016/j.jpeds.2022.09.029. Epub 2022 Sep 28. PMID: 36179887.. Letouzey M, et al. J Pediatr 2022 Apr;243:91–98.e4. doi: 10.1016/j.jpeds.2021.11.075. Epub 2021 Dec 21. PMID: 34942178. Köstlin-Gille N, et al. Arch Dis Child Fetal Neonatal Ed 2023 Nov;108(6):623–630. doi: 10.1136/archdischild-2022-325113. Epub 2023 May 3. PMID: 37137680. Puopolo KM, et al. Pediatrics 2017 Nov;140(5):e20170925. doi: 10.1542/peds.2017-0925. Epub 2017 Oct 5. PMID: 28982710; PMCID: PMC5654397. Garber SJ, et al. J Perinatol 2021 Feb;41(2):255–262. doi: 10.1038/s41372-020-00784-y. Epub 2020 Aug 13. PMID: 32792629; PMCID: PMC7881045. Morales-Betancourt C, et al. Front Pediatr 2022 May 31;10:913175. doi: 10.3389/fped.2022.913175. PMID: 35712636; PMCID: PMC9192948.