Antibiotic Use for Sepsis in Hospitalized Neonates in Botswana: Factors Associated with Guideline-Divergent Prescribing
Abstract
:1. Introduction
2. Materials and Methods
2.1. Setting and Population
2.2. Study Cohort
2.3. Study Data, Outcome, and Covariates
2.4. Analysis
3. Results
3.1. Characteristics of Cohort
3.2. Guideline-Divergent Antibiotic Use
3.3. Independent Factors Associated with Guideline-Divergent Use of Antibiotics
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
EOS (n = 12) | LOS (n = 13) | |
---|---|---|
Susceptibility to WHO First-Line Antibiotics Resistant Sensitive | ||
3 (25%) | 6 (46%) | |
8 (67%) | 7 (54%) | |
Antibiotics prescribed WHO Guideline-divergent WHO Guideline-synchronous | ||
1 (8%) | 10 (77%) | |
10 (83%) | 1 (8%) |
Group | Time of Neonatal Sepsis Onset | # | Antibiotic 1 | Antibiotic 2 | Antibiotic 3 | Antibiotic 4 |
---|---|---|---|---|---|---|
Incomplete guideline treatment, n = 12 | EOS EOS | 2 10 | Gentamicin Ampicillin | |||
One guideline antibiotic plus additional non-guideline antibiotic, n = 2 | EOS EOS | 1 1 | Ampicillin Ampicillin | Erythromycin Vancomycin | ||
Guideline antibiotics plus additional non-guideline antibiotics, n = 6 | EOS EOS EOS EOS EOS | 1 1 2 1 1 | Ampicillin Ampicillin Ampicillin Ampicillin Ampicillin | Gentamicin Gentamicin Gentamicin Gentamicin Gentamicin | Piperacillin–Tazobactam Metronidazole Cefotaxime Piperacillin–Tazobactam Vancomycin | Amikacin |
Non-guideline antibiotics, n = 11 | LOS EOS LOS LOS LOS LOS | 5 1 1 2 1 1 | Amikacin Vancomycin Vancomycin Meropenem Meropenem Meropenem | Piperacillin–Tazobactam Cefotaxime Cefotaxime Cefotaxime Vancomycin |
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Covariate | Study Sample (N = 325) |
---|---|
Median EGA 1, weeks (IQR) | 34 (30–38) |
Median Birthweight, grams (IQR) | 1795 (1328–2825) |
Infant Sex | |
Female | 167 (52%) |
Male | 153 (48%) |
HIV Exposure | |
Yes | 81 (25%) |
No | 244 (75%) |
Median Duration of Stay 2, days (IQR) | 8 (4–16) |
Median Maternal Age, years (IQR) | 29 (24–35) |
Delivery Mode | |
Vaginal | 223 (69%) |
Cesarean section | 101 (31%) |
Discharge Status | |
Alive | 290 (89%) |
Deceased | 35 (11%) |
Exposure | Antibiotic Utilization | p-Value 1 | |
---|---|---|---|
Guideline- Divergent Use n = 31 n | Guideline- Synchronous Use n = 294 n | ||
Time of Neonatal Sepsis Onset EOS 2 LOS 3 Day of Life at Sepsis Onset All episodes, median (IQR) EOS, median (IQR) LOS, median (IQR) | |||
23 (8%) | 270 (92%) | 0.0057 | |
8 (25%) | 24 (75%) | ||
2 (1–3.5) | 1 (1–2) | <0.001 | |
1 (1–2.5) | 1 (1–2) | ||
9 (5–17.75) | 4 (4–4) | ||
EGA Median (IQR) <28 weeks 28–31 weeks 32–36 weeks ≥37 weeks | |||
31 (29–34) | 34 (31–38) | <0.001 | |
6 (23%) | 20 (77%) | ||
10 (13%) | 69 (87%) | ||
9 (8%) | 105 (92%) | ||
6 (6%) | 96 (94%) | ||
Blood Culture Collected Yes No | |||
22 (10%) | 194 (90%) | 0.6908 | |
9 (8%) | 100 (92%) |
Exposure | Antibiotic Utilization | |||
---|---|---|---|---|
OR (95% CI) | p-Value | aOR 1 (95% CI) | p-Value | |
Time of Neonatal Sepsis Onset EOS (n = 294) LOS (n = 31) | ||||
1.00 | 0.0032 | 1.00 | 0.0011 | |
3.91 (1.51, 9.94) | 4.89 (1.81, 12.57) | |||
EGA Continuous 2 | ||||
0.89 (0.81, 0.97) | 0.0088 | - | - |
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Dowling, J.; Arscott-Mills, T.; Bayani, O.; Boustany, M.; Moorad, B.; Richard-Greenblatt, M.; Tlhako, N.; Zalot, M.; Steenhoff, A.P.; Gezmu, A.M.; et al. Antibiotic Use for Sepsis in Hospitalized Neonates in Botswana: Factors Associated with Guideline-Divergent Prescribing. Microorganisms 2023, 11, 2641. https://doi.org/10.3390/microorganisms11112641
Dowling J, Arscott-Mills T, Bayani O, Boustany M, Moorad B, Richard-Greenblatt M, Tlhako N, Zalot M, Steenhoff AP, Gezmu AM, et al. Antibiotic Use for Sepsis in Hospitalized Neonates in Botswana: Factors Associated with Guideline-Divergent Prescribing. Microorganisms. 2023; 11(11):2641. https://doi.org/10.3390/microorganisms11112641
Chicago/Turabian StyleDowling, Jameson, Tonya Arscott-Mills, One Bayani, Mickael Boustany, Banno Moorad, Melissa Richard-Greenblatt, Nametso Tlhako, Morgan Zalot, Andrew P. Steenhoff, Alemayehu M. Gezmu, and et al. 2023. "Antibiotic Use for Sepsis in Hospitalized Neonates in Botswana: Factors Associated with Guideline-Divergent Prescribing" Microorganisms 11, no. 11: 2641. https://doi.org/10.3390/microorganisms11112641