{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T02:47:00Z","timestamp":1776394020797,"version":"3.51.2"},"reference-count":26,"publisher":"Cambridge University Press (CUP)","issue":"9","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0899823X2510233X_as1\">\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To compare temporal trends, variation, and correlations between antibiotic use metrics across U.S. neonatal intensive care units (NICUs) and assess associations with mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X2510233X_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 438,156 infants admitted to 272 NICUs from 2017 to 2021 using the Premier Health Database. Antibiotic use rate (AUR), days of therapy (DOT), and antibiotic spectrum index (ASI) per 1,000 patient or therapy days were calculated both cumulatively by year and at the center level. Mixed-effects models adjusted for center-level characteristics were used for all analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X2510233X_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      All three metrics declined over time: AUR by 16.8%, DOT by 19.0%, and ASI by 2.5%. AUR and DOT were highly correlated (\n                      <jats:italic>r<\/jats:italic>\n                      = 0.989,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001), while ASI showed weaker correlations with AUR (\n                      <jats:italic>r<\/jats:italic>\n                      = 0.247,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001) and DOT (\n                      <jats:italic>r<\/jats:italic>\n                      = 0.338,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001). None were significantly associated with center-level mortality. ASI had the least variability, indicating more uniform antibiotic selection and lower center-level discriminatory value.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X2510233X_as4\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>DOT and AUR were comparable measures of antibiotic consumption, both showing significant declines. ASI exhibited the least variability, reflecting more consistency in antibiotic selection. The similarity in dispersion and decline between AUR and DOT suggests that neonatal antibiotic exposure is primarily influenced by initiation and discontinuation decisions rather than regimen complexity. Given its ease of calculation, AUR may be the most practical metric for evaluating the impact of antibiotic stewardship interventions at the center level.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ice.2025.10233","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T06:03:24Z","timestamp":1755583404000},"page":"903-909","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of metrics of neonatal intensive care unit antibiotic use"],"prefix":"10.1017","volume":"46","author":[{"given":"Alvaro","family":"Zevallos Barboza","sequence":"first","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia"},{"name":"Children\u2019s Hospital of Philadelphia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sagori","family":"Mukhopadhyay","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia"},{"name":"Children\u2019s Hospital of Philadelphia"},{"name":"University of Pennsylvania Perelman School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen Marie","family":"Puopolo","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia"},{"name":"Children\u2019s Hospital of Philadelphia"},{"name":"University of Pennsylvania Perelman School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7564-5186","authenticated-orcid":false,"given":"Di","family":"Shu","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia"},{"name":"University of Pennsylvania Perelman School of Medicine"},{"name":"University of Pennsylvania Perelman School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3076-3186","authenticated-orcid":false,"given":"Jeffrey S.","family":"Gerber","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia"},{"name":"University of Pennsylvania Perelman School of Medicine"},{"name":"Children\u2019s Hospital of Philadelphia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2883-4683","authenticated-orcid":false,"given":"Dustin Daniel","family":"Flannery","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia"},{"name":"Children\u2019s Hospital of Philadelphia"},{"name":"University of Pennsylvania Perelman School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"S0899823X2510233X_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(16)30205-5"},{"key":"S0899823X2510233X_ref16","doi-asserted-by":"publisher","DOI":"10.1007\/978-0-387-32833-1_379"},{"key":"S0899823X2510233X_ref21","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-2894"},{"key":"S0899823X2510233X_ref12","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2023-065098"},{"key":"S0899823X2510233X_ref20","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-2896"},{"key":"S0899823X2510233X_ref9","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2019-2963"},{"key":"S0899823X2510233X_ref22","doi-asserted-by":"publisher","DOI":"10.1038\/s41372-023-01826-x"},{"key":"S0899823X2510233X_ref23","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/piaa022"},{"key":"S0899823X2510233X_ref15","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2019.221"},{"key":"S0899823X2510233X_ref3","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.2010.tb04026.x"},{"key":"S0899823X2510233X_ref5","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-0115"},{"key":"S0899823X2510233X_ref24","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2018-0265"},{"key":"S0899823X2510233X_ref11","doi-asserted-by":"publisher","DOI":"10.1038\/s41372-018-0041-y"},{"key":"S0899823X2510233X_ref19","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016293"},{"key":"S0899823X2510233X_ref10","first-page":"1","article-title":"Improved use of antibiotics following implementation of antimicrobial stewardship in a neonatal intensive care unit","volume":"11","author":"Karelsdottir","year":"2024","journal-title":"Infect Control Hosp Epidemiol"},{"key":"S0899823X2510233X_ref7","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2023.3664"},{"key":"S0899823X2510233X_ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.semperi.2020.151329"},{"key":"S0899823X2510233X_ref25","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2019-1105"},{"key":"S0899823X2510233X_ref6","doi-asserted-by":"publisher","DOI":"10.1038\/s41372-024-01885-8"},{"key":"S0899823X2510233X_ref26","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2021-006253"},{"key":"S0899823X2510233X_ref4","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014-3409"},{"key":"S0899823X2510233X_ref14","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2021.467"},{"key":"S0899823X2510233X_ref1","doi-asserted-by":"publisher","DOI":"10.1586\/14787210.2015.1040766"},{"key":"S0899823X2510233X_ref13","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2017.94"},{"key":"S0899823X2510233X_ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2023.106710"},{"key":"S0899823X2510233X_ref17","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2023-326734"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X2510233X","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T01:59:46Z","timestamp":1776391186000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X2510233X\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,19]]},"references-count":26,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["S0899823X2510233X"],"URL":"https:\/\/doi.org\/10.1017\/ice.2025.10233","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,19]]},"assertion":[{"value":"\u00a9 The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}