662 - Antibiotic use in Swedish neonatal units: A nationwide population-based cohort

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 662
Publication Number: 662.241

Johan Gyllensvärd, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Jönköping, Jonkopings Lan, Sweden; Marie Studahl, Biomedicine, Gothenburg, Vastra Gotaland, Sweden; Lars Gustavsson, Institute of biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Vastra Gotaland, Sweden; Elisabet Hentz, Saglgrenska university hospital Gothenburg Sweden, Goteborg, Vastra Gotaland, Sweden; Karin Åkesson, Linköping University, Jönköping, Jonkopings Lan, Sweden; Huiqi Li, University of Gothenburg, Gothenburg, Vastra Gotaland, Sweden; Mikael Norman, Karolinska Institutet & Karolinska University Hospital, Stockholm, Stockholms Lan, Sweden; Anders Elfvin, University of Gothenburg, Gothenburg, Vastra Gotaland, Sweden

Presenting Author(s)

Johan Gyllensvärd (he/him/his)

Trainee
Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Jönköping, Jonkopings Lan, Sweden

Background: Antibiotic use varies between neonatal units. The magnitude of this variation, and its relation to outcome, have not been studied in Sweden.

Objective: To study the numbers and proportions of newborn infants treated with antibiotics in the first week of life, incidence of early-onset sepsis (EOS), and mortality among late preterm and term newborns in Sweden.

Design/Methods:

All hospital live births from 34 weeks’ gestation (n=1 025 515) during 2012-2020 were included in this nationwide population-based cohort. Data were collected from the Swedish Neonatal Quality Register and the Swedish Medical Birth Register. The primary outcome was the usage of systematic antibiotics in the first week of life. Secondary outcomes were the duration of antibiotic treatment, the incidence of culture-proven EOS, and EOS-associated mortality.

Results:

A total of 19 286 (1.9%; 95% CI: 1.85% - 1.91%) newborns (7686 girls [39.9%], median [IQR] gestational age 40 [38 – 41] weeks, median [IQR] birth-weight 3610 [3140 – 4030] g) received antibiotics during the first week of life with a range between different neonatal units from 0.9% to 4.3% (p< 0.001). Antibiotic use was lower in level I units (1.6%) than in level II and level III units (1.9% and 1.9%, respectively, p< 0.001) and the duration of antibiotic treatment was 102 days per 1000 live births in level I, 114 days in level II and 113 days per 1000 live births in level III units. In contrast, the incidence of EOS was higher in level I (1.1 newborns per 1000 live births) than at level II (0.71) and III hospitals (0.39 newborns per 1000 live births). The majority of EOS was caused by group B streptococci (0.34 per 1000 live births). Mortality associated with EOS was 1.39% (9 of 649 newborns). For each infant with EOS, 30 infants were started on antibiotics and 179 antibiotic days were administered.

The median (IQR) duration of antibiotic treatment in infants without EOS was 5 (3 - 7) days, with a range between neonatal units from 3 (2 - 6) to 7 (3 - 10) days.

Conclusion(s): In spite of an overall low rate, there was significant variation in antibiotic use and treatment duration between Swedish neonatal units. The incidence of culture-proven EOS was in line with other international reports and the mortality rate associated with EOS was low.