Variations in antibiotic use in late preterm and term newborns from 2012 to 2020: a nationwide population-based observational study

Objective To quantify regional and unit variations in antibiotic use during the first week of life, incidence of early-onset sepsis (EOS) and mortality in late-preterm and term newborns in Sweden. Design A nationwide cohort study. Setting The Swedish Neonatal Quality Register, a register of all newborns admitted for neonatal care in Sweden. Patients All late-preterm and term newborns (≥34 weeks’ gestation) admitted to a neonatal unit from 1 January 2012 to 31 December 2020. Main outcome measures The proportion of antibiotic use, incidence of EOS and mortality in late-preterm and term newborns. Results Out of 1 025 515 newborns, 19 286 neonates (1.9%) received antibiotics with a 2-fold to 5-fold variation across regions (1.3%–3.0%) and units (0.9%–4.3%). Duration of antibiotic therapy (median) varied across regions from 7–10 days for infants with EOS, and 4–7 days for infants with no sepsis. Incidence of EOS ranged from 0.33 to 0.93 per 1000 live births between regions. The number of infants treated per EOS case varied 2-fold to 15-fold across regions (22–39) and units (7–113). All-cause mortality and EOS-associated mortality ranged across regions from 0.21 to 0.54 per 1000 live births and 0.0 to 34.9 (3 of 86 newborns) per 1000 infants with EOS. Conclusions This nationwide study revealed wide variations in antibiotic use and in the number of infants treated per EOS case. The results indicate a disproportionate antibiotic use in relation to the incidence of EOS. This emphasises the need for future efforts to minimise unwarranted antibiotic use.