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Antimicrobial utilization in very-low-birth-weight infants: association with probiotic use

Journal of Perinatology volume 42, pages 947–952 (2022)Cite this article

Subjects

Abstract

Objective

To examine the association between probiotic use and antimicrobial utilization.

Study design

We retrospectively evaluated very-low-birth-weight (VLBW) infants admitted to tertiary neonatal intensive care units in Canada between 2014 and 2019. Our outcome was antimicrobial utilization rate (AUR) defined as number of days of antimicrobial exposure per 1000 patient-days.

Result

Of 16,223 eligible infants, 7279 (45%) received probiotics. Probiotic use rate increased from 10% in 2014 to 68% in 2019. The AUR was significantly lower in infants who received probiotics vs those who did not (107 vs 129 per 1000 patient-days, aRR = 0.89, 95% CI [0.81, 0.98]). Among 13,305 infants without culture-proven sepsis or necrotizing enterocolitis ≥Stage 2, 5931 (45%) received probiotics. Median AUR was significantly lower in the probiotic vs the no-probiotic group (78 vs 97 per 1000 patient-days, aRR = 0.85, 95% CI [0.74, 0.97]).

Conclusion

Probiotic use was associated with a significant reduction in AUR among VLBW infants.

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Fig. 1: Study Flow Diagram.

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Acknowledgements

The authors thank all site investigators and data abstractors of the Canadian Neonatal Network (CNN). A list of participating CNN site investigators and their affiliations is presented in the Supplementary Infromation. We thank the staff at the Maternal-infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, Canada, for organizational support of the CNN. In particular, we thank Heather McDonald Kinkaid, PhD, a scientific writer at MiCare, for editorial support in preparing this paper.

Funding

Although no specific funding was received for this study, organizational support for the Canadian Neonatal Network was provided by the Maternal-infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by the Canadian Institutes of Health Research (CTP 87518), the Ontario Ministry of Health and Long-Term Care, and Mount Sinai Hospital. Dr JYT receives salary support from the Investigator Grant Award Program of the British Columbia Children’s Hospital Research Institute.

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Alberta, Edmonton, AB, Canada

    Joseph Y. Ting

  2. Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada

    Joseph Y. Ting

  3. Maternal-infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada

    Eugene W. Yoon & Prakesh S. Shah

  4. Department of Pediatrics, University of Calgary, Calgary, AB, Canada

    Carlos A. Fajardo

  5. Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada

    Thierry Daboval

  6. Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC, Canada

    Valérie Bertelle

  7. Department of Paediatrics, University of Toronto, Toronto, ON, Canada

    Prakesh S. Shah

  8. Mount Sinai Hospital, Toronto, ON, Canada

    Prakesh S. Shah & Shoo K. Lee

  9. Montreal Children’s Hospital at McGill University Health Centre, Montréal, QC, Canada

    Marc Beltempo & Martine Claveau

  10. Victoria General Hospital, Victoria, BC, Canada

    Jaideep Kanungo

  11. British Columbia Women’s Hospital, Vancouver, BC, Canada

    Jonathan Wong

  12. Royal Columbian Hospital, New Westminster, BC, Canada

    Zenon Cieslak

  13. Surrey Memorial Hospital, Surrey, BC, Canada

    Rebecca Sherlock

  14. Foothills Medical Centre, Calgary, AB, Canada

    Ayman Abou Mehrem

  15. Royal Alexandra Hospital, Edmonton, AB, Canada

    Jennifer Toye & Joseph Y. Ting

  16. Alberta Children’s Hospital, Calgary, AB, Canada

    Carlos Fajardo

  17. Regina General Hospital, Regina, SK, Canada

    Jaya Bodani

  18. Royal University Hospital, Saskatoon, SK, Canada

    Lannae Strueby

  19. Winnipeg Health Sciences Centre, Winnipeg, MB, Canada

    Mary Seshia & Deepak Louis

  20. St. Boniface General Hospital, Winnipeg, MB, Canada

    Ruben Alvaro

  21. Hamilton Health Sciences Centre, Hamilton, ON, Canada

    Amit Mukerji

  22. London Health Sciences Centre, London, ON, Canada

    Orlando Da Silva

  23. Windsor Regional Hospital, Windsor, ON, Canada

    Sajit Augustine

  24. Hospital for Sick Children, Toronto, ON, Canada

    Kyong-Soon Lee

  25. Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Eugene Ng

  26. The Ottawa Hospital, Ottawa, ON, Canada

    Brigitte Lemyre

  27. Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada

    Thierry Daboval

  28. Kingston General Hospital, Kingston, ON, Canada

    Faiza Khurshid

  29. Jewish General Hospital, Montréal, QC, Canada

    Victoria Bizgu

  30. Hôpital Sainte-Justine, Montréal, QC, Canada

    Keith Barrington, Anie Lapointe & Guillaume Ethier

  31. Centre Hospitalier Universitaire de Québec, Sainte Foy, QC, Canada

    Christine Drolet & Bruno Piedboeuf

  32. Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada

    Marie St-Hilaire

  33. Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada

    Valerie Bertelle & Edith Masse

  34. Moncton Hospital, Moncton, New Brunswick, Canada

    Roderick Canning

  35. Everett Chalmers Hospital, Fredericton, NB, Canada

    Hala Makary

  36. Saint John Regional Hospital, Saint John, NB, Canada

    Cecil Ojah & Luis Monterrosa

  37. Janeway Children’s Health and Rehabilitation Centre, St. John’s, NF, Canada

    Julie Emberley

  38. IWK Health Centre, Halifax, NS, Canada

    Jehier Afifi

  39. Cape Breton Regional Hospital, Sydney, NS, Canada

    Andrzej Kajetanowicz

Authors
  1. Joseph Y. Ting
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  2. Eugene W. Yoon
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  3. Carlos A. Fajardo
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  4. Thierry Daboval
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  5. Valérie Bertelle
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  6. Prakesh S. Shah
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Consortia

Canadian Neonatal Network (CNN) Investigators

  • Prakesh S. Shah
  • , Marc Beltempo
  • , Jaideep Kanungo
  • , Jonathan Wong
  • , Zenon Cieslak
  • , Rebecca Sherlock
  • , Ayman Abou Mehrem
  • , Jennifer Toye
  • , Joseph Y. Ting
  • , Carlos Fajardo
  • , Jaya Bodani
  • , Lannae Strueby
  • , Mary Seshia
  • , Deepak Louis
  • , Ruben Alvaro
  • , Amit Mukerji
  • , Orlando Da Silva
  • , Sajit Augustine
  • , Kyong-Soon Lee
  • , Eugene Ng
  • , Brigitte Lemyre
  • , Thierry Daboval
  • , Faiza Khurshid
  • , Victoria Bizgu
  • , Keith Barrington
  • , Anie Lapointe
  • , Guillaume Ethier
  • , Christine Drolet
  • , Bruno Piedboeuf
  • , Martine Claveau
  • , Marie St-Hilaire
  • , Valerie Bertelle
  • , Edith Masse
  • , Roderick Canning
  • , Hala Makary
  • , Cecil Ojah
  • , Luis Monterrosa
  • , Julie Emberley
  • , Jehier Afifi
  • , Andrzej Kajetanowicz
  •  & Shoo K. Lee

Contributions

JYT conceptualized and designed the study, interpreted the data, drafted the paper, and critically revised the paper for important intellectual content. EWY conducted the statistical analysis, interpreted the data, and critically revised the paper. PSS conceptualized and designed the study, contributed to the statistical analysis and interpreted the data, critically revised the paper for important intellectual content, obtained funding, and provided technical and material support as well as overall study supervision. CAF, TD, and VB interpreted the study data and critically reviewed and revised the paper for important intellectual content. All authors approved the final version of this paper as submitted, and all agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Prakesh S. Shah.

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The authors declare no competing interests.

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Ting, J.Y., Yoon, E.W., Fajardo, C.A. et al. Antimicrobial utilization in very-low-birth-weight infants: association with probiotic use. J Perinatol 42, 947–952 (2022). https://doi.org/10.1038/s41372-022-01382-w

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  • DOI: https://doi.org/10.1038/s41372-022-01382-w

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