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. 2023 Sep 9;12(9):1426.
doi: 10.3390/antibiotics12091426.

Procalcitonin-Based Antibiotic Use for Neonatal Early-Onset Bacterial Infections: Pre- and Post-Intervention Clinical Study

Hidetoshi Go  1 , Nobuhiko Nagano  1 , Yuki Sato  1 , Daichi Katayama  1 , Koichiro Hara  1 , Takuya Akimoto  1 , Takayuki Imaizumi  1 , Ryoji Aoki  1   2 , Midori Hijikata  1 , Ayako Seimiya  1 , Aya Okahashi  1 , Ichiro Morioka  1
Affiliations

Procalcitonin-Based Antibiotic Use for Neonatal Early-Onset Bacterial Infections: Pre- and Post-Intervention Clinical Study

Hidetoshi Go et al. Antibiotics (Basel). .

Abstract

We previously reported the 95th percentile cutoff value of the serum procalcitonin (PCT) reference curve for diagnosing early-onset bacterial infection. We aimed to verify the effectivity of these novel diagnostic criteria by comparing antibiotic use and incidence of early-onset bacterial infection between pre- and post-introduction periods. We included newborns admitted to our neonatal intensive care unit who underwent blood tests within 72 h after birth between 2018 and 2022. The neonates were divided into the pre-intervention (admitted before the introduction, n = 737) or post-intervention (admitted after the introduction, n = 686) group. The days of antibiotics therapy (DOT) per 1000 patient days up to 6 days after birth, percentage of antibiotic use, and incidence of early-onset bacterial infection were compared between the groups. The post-intervention group had significantly lower DOT per 1000 patient days (82.0 days vs. 211.3 days, p < 0.01) and percentage of newborns receiving antibiotics compared with the pre-intervention group (79 (12%) vs. 280 (38%), respectively, p < 0.01). The incidence of early-onset bacterial infections did not differ between the groups (2% each, p = 0.99). In conclusion, our diagnostic criteria using the 95th percentile cutoff value of the serum PCT reference curve for early-onset bacterial infection were proven safe and effective, promoting appropriate use of antibiotics.

Keywords: antibiotic resistance; antibiotics; appropriate use of antibiotics; days of antibiotic therapy; early-onset bacterial infection; procalcitonin.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the participants. NICU, neonatal intensive care unit.
Figure 2
Figure 2
Change in the proportion of patients who received antibiotic therapy between the Pre- and Post-Groups.
Figure 3
Figure 3
The histograms of Pre-Group and Post-Group. Based on the frequency of trends obtained from the PS, the histograms of Pre-Group and Post-Group are shown in the upper and lower rows, respectively. PS, propensity score.
Figure 4
Figure 4
Protocol for use of antibiotics in preterm and term infants. CRP, C-reactive protein; IgM, immunoglobulin M; PCT, procalcitonin; WBC, white blood cell.
Figure 5
Figure 5
Serum PCT reference curves for preterm and term infants. These figures are cited from reference [21]. Solid and dotted lines indicate the 50th and 95th percentile lines, respectively. PCT, procalcitonin.
See this image and copyright information in PMC

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