SAN DIEGO – Antibiotic stewardship is important for every patient population, but it’s especially crucial in the care of infants hospitalized in the neonatal intensive care unit and in infants and children with cystic fibrosis, Dr. Lisa Saiman said at IDWeek 2012.
The use of antibiotics in these two pediatric populations "is clearly different," said Dr. Saiman, professor of clinical pediatrics at Columbia University Medical Center, N.Y. "In the NICU, approximately 80% of preterm babies will get IV antibiotics for early-onset sepsis and 20%-30% for late-onset sepsis. In the CF population, everybody gets antibiotics throughout their entire lives. In the NICU, we use relatively few agents because of concerns about toxicity and dosing, while in the CF population the number of agents used is enormous."
Both of these patient populations "have existing networks consisting of care centers of excellence and very motivated providers," noted Dr. Saiman, who is also the hospital epidemiologist for Morgan Stanley Children’s Hospital of New York-Presbyterian. "In the United States, it’s estimated that about 500,000 infants are hospitalized in the neonatal ICU each year, and there are about 30,000 people with CF, making this a rare disease."
In a published study of 323 courses of antibiotics administered in the NICU, Dr. Saiman and her associates found that 35% of infants received at least 1 day of inappropriate antibiotics (Pediatr. Infect. Dis. J. 2009;28:1047-51). The consequences of inappropriate antibiotic use in these two patient populations are potentially dire. In NICU patients, Dr. Saiman said, this practice could result in necrotizing endocarditis, candidemia, nephrotoxicity, ototoxicity, and drug-drug interactions. In CF patients, inappropriate antibiotic use could lead to the emergence of multidrug-resistant strains of Pseudomonas aeruginosa and of other organisms, life-threatening allergies, nephrotoxicity, ototoxicity, hepatotoxicity, phototoxicity, Clostridium difficile infection, and drug-drug interactions.
To optimize antibiotic prescribing practices in these two patient populations, Dr. Saiman advised obtaining "buy-in from key stakeholders from the beginning. Review and implement evidence-based practices to develop local guidelines. Obtain local data and provide feedback to your care teams."
Dr. Saiman disclosed that she served on the advisory boards of Novartis, Vertex, and Insmed. She has also received funding from the CF Foundation.
IDWeek is the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.