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Short-course antibiotic therapy for pneumonia in the neonatal intensive care unit

Journal of Perinatology volume 43, pages 1145–1151 (2023)Cite this article

Subjects

Abstract

Objective

To determine the adherence and safety outcomes of a 5-day antibiotic course with a “time-out” for treatment of “blood culture-negative” pneumonia in the NICU.

Study design

Prospective surveillance of all infants diagnosed with pneumonia at 7 NICUs from 8/2020-12/2021. Safety outcomes were defined a priori by re-initiation of antibiotic therapy within 14 days after discontinuation and overall and sepsis-related mortality.

Results

128 infants were diagnosed with 136 episodes of pneumonia; 88% (n = 119) were treated with 5 days of definitive antibiotic therapy. Antibiotics were restarted within 14 days in 22 (16%) of the 136 pneumonia episodes. However, only 3 (3%) of the 119 episodes of pneumonia treated for 5 days had antibiotics restarted for pneumonia. Mortality was 5% (7/128); 5 of the 7 deaths were assessed as sepsis-related.

Conclusion

Adherence to the 5-day definitive antibiotic treatment for “culture-negative” pneumonia was high and the intervention seemed safe.

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Data availability

The de-identified dataset generated from the study is available from the corresponding author on reasonable request and following approval by the Institutional Review Board of Nationwide Children’s Hospital.

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Acknowledgements

The study was presented in part as poster presentations at the Pediatric Academic Societies Meeting, Denver, CO on 4/25/2022, Midwest Society for Pediatric Research, Chicago, IL on 9/29/2022, and St. Jude/PIDS Pediatric Infectious Diseases Research Conference, Memphis, TN, on 3/2/2023.

Funding

ZSL received a Pediatric Infectious Diseases Society Summer Research Scholar Award (SUMMERS) for his work on this study.

Author information

Author notes

  1. A full list of members and their affiliations appears in the Supplementary Information.

Authors and Affiliations

  1. The Ohio State University, Columbus, OH, USA

    Zachery S. Lewald

  2. Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, USA

    Zachery S. Lewald, Matthew J. Kielt, Concepción de Alba Romero & Pablo J. Sánchez

  3. Division of Neonatology, Nationwide Children’s Hospital, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, USA

    Zachery S. Lewald, Matthew J. Kielt, Concepción de Alba Romero & Pablo J. Sánchez

  4. Division of Pediatric Infectious Diseases, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, USA

    Zachery S. Lewald & Pablo J. Sánchez

  5. Department of Pharmacy, Nationwide Children’s Hospital, Columbus, OH, USA

    Pavel Prusakov, Jacqueline K. Magers, Caitlyn Schwirian, Wai-Yin Mandy Tam & Alexandra F. Burton

  6. Division of Neonatology, Hospital 12 de Octubre, Madrid, Spain

    Concepción de Alba Romero

  7. Pediatrix Medical Group of Ohio, Columbus, OH, USA

    Natalie O. White, Randy R. Miller & Maclain J. Magee

  8. Central Ohio Newborn Medicine, Columbus, OH, USA

    Richard Moraille & Anthony R. Theile

  9. Department of Pediatrics, Division of Neonatology, Nationwide Children’s Hospital, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, USA

    Pablo J. Sánchez, Alexandra K. Medoro, Maria Jebbia & Roopali Bapat

  10. Department of Pediatrics, Division of Pediatric Infectious Diseases, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, USA

    Pablo J. Sánchez, Alexandra K. Medoro, Joshua R. Watson & Katia C. Halabi

  11. Department of Neonatal Nurse Practitioners, Nationwide Children’s Hospital, The Ohio State Wexner Medical Center, Columbus, OH, USA

    Melinda Albertson & Tommy Nathaniel Johnson-Roddenberry

  12. Department of Clinical Outcomes, Nationwide Children’s Hospital, Columbus, OH, USA

    Malak Abdel-Hadi

Authors
  1. Zachery S. Lewald
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  2. Pavel Prusakov
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  3. Jacqueline K. Magers
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  4. Matthew J. Kielt
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  5. Concepción de Alba Romero
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  6. Natalie O. White
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  7. Randy R. Miller
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  8. Richard Moraille
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  9. Anthony R. Theile
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  10. Pablo J. Sánchez
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Consortia

Nationwide Children’s Hospital Neonatal Antimicrobial Stewardship Program (NEO-ASP)

  • Pablo J. Sánchez
  • , Jacqueline K. Magers
  • , Pavel Prusakov
  • , Natalie O. White
  • , Randy R. Miller
  • , Richard Moraille
  • , Anthony R. Theile
  • , Alexandra K. Medoro
  • , Joshua R. Watson
  • , Melinda Albertson
  • , Caitlyn Schwirian
  • , Wai-Yin Mandy Tam
  • , Alexandra F. Burton
  • , Tommy Nathaniel Johnson-Roddenberry
  • , Maria Jebbia
  • , Maclain J. Magee
  • , Katia C. Halabi
  • , Malak Abdel-Hadi
  •  & Roopali Bapat

Contributions

ZSL collected and analyzed the data, assisted with the analyses, wrote the first draft of the manuscript, and reviewed and revised the manuscript. PP conceptualized and designed the study, designed the data collection instruments, collected data, assisted with the analyses, and reviewed and revised the manuscript. JKM conceptualized and designed the study, collected data, and reviewed and revised the manuscript. MJK assisted with the analyses, reviewed and revised the manuscript. CdAR collected and helped to analyze the data, reviewed and revised the manuscript, and approved the final manuscript as submitted. NOW conceptualized and designed the study, reviewed and revised the manuscript. RRM conceptualized and designed the study, reviewed and revised the manuscript. RM conceptualized and designed the study, reviewed and revised the manuscript. ART conceptualized and designed the study, reviewed and revised the manuscript. PJS conceptualized and designed the study, coordinated and supervised data collection, analyzed the data, and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Pablo J. Sánchez.

Ethics declarations

Competing interests

PP received grant funding from Merck & Co. unrelated to this study. Other authors have no conflicts of interest relevant to this article to disclose.

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Lewald, Z.S., Prusakov, P., Magers, J.K. et al. Short-course antibiotic therapy for pneumonia in the neonatal intensive care unit. J Perinatol 43, 1145–1151 (2023). https://doi.org/10.1038/s41372-023-01720-6

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