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Barca HC, Ferber J, Richards M, Strickland M, Fernandez AJ, Li DK, Darrow LA. Antimicrobial exposure during infancy in a longitudinal California cohort. Pediatr Res 2024; 96:805-813. [PMID: 38570559 DOI: 10.1038/s41390-024-03171-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND To describe temporal and sociodemographic patterns of antimicrobial exposure during the first year of life in a large US cohort. METHODS Singleton infants born 1998-2014 enrolled in Kaiser Permanente Northern California integrated health system (n = 345,550) were followed longitudinally via comprehensive electronic health records, capturing all systemic antimicrobial inpatient administrations and outpatient dispensings. Antimicrobial exposure was summarized by maternal and infant characteristics, birth year, inpatient/outpatient status, age in months, and drug class. RESULTS Overall, 44% of infants in this cohort received at least one dose of antimicrobials during infancy. Decreases over time were driven by reduced outpatient dispensings specifically in later infancy, primarily for penicillins. Among infants receiving any antimicrobials the median number of exposure-days was 16. Inpatient dispensings peaked in the first 30 days of life and outpatient dispensings peaked at 10-11 months. Birth characteristics (i.e., NICU admission, gestational age) were strong independent predictors of antimicrobial exposure between 0- < 3 months; sociodemographic factors were modest predictors of exposure for 3-12 months. CONCLUSION Predictors of antimicrobial exposure in early and late infancy are distinct with early infancy exposures highly correlated to birth characteristics. The cumulative proportion of infants exposed has decreased due to fewer late infancy outpatient dispensings. IMPACT Comprehensive antimicrobial exposure histories and the maternal and infant characteristics predicting exposure have not been well described in US populations. This analysis provides estimates of cumulative antimicrobial exposures by sociodemographic factors, delivery characteristics, month of life, inpatient/outpatient status, and antibiotic class among one of the largest US HMOs. Predictors of early infancy antimicrobial exposures differ from those in late infancy, with early exposures strongly correlated to birth characteristics and late infancy exposures modestly related to sociodemographic factors. Antimicrobial exposure among infants decreased over the time period primarily due to reduced outpatient dispensings in later infancy.
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Affiliation(s)
- Hannah C Barca
- School of Public Health, University of Nevada, Reno, Reno, NV, USA.
| | | | - Megan Richards
- School of Public Health, University of Nevada, Reno, Reno, NV, USA
| | | | | | - De-Kun Li
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Lyndsey A Darrow
- School of Public Health, University of Nevada, Reno, Reno, NV, USA
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Chen LY, Flood-Grady E, Hentschel A, Wright L, Mkuu R, Young A, Francois M, Neu J, Parker LA, Shenkman E, Krieger JL, Lemas DJ. A Qualitative Study of Pregnant Women's Perspectives on Antibiotic Use for Mom and Child: Implications for Developing Tailored Health Education Interventions. Antibiotics (Basel) 2020; 9:antibiotics9100704. [PMID: 33076539 PMCID: PMC7602878 DOI: 10.3390/antibiotics9100704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 11/21/2022] Open
Abstract
The overutilization of antibiotics during pregnancy and early life are associated with adverse health outcomes for mothers and infants. In this study, we explored pregnant women’s opinions and concerns of antibiotics and how perceptions may affect their health-related decision-making. We conducted 18 in-depth, semi-structured interviews with pregnant women and used the Health Belief Model (HBM) as a framework to analyze the data. We found that mothers generally understood the benefits of antibiotics and were aware that antibiotics are clinically effective for treating bacterial infections. Importantly, perceived barriers related to antibiotic use included concerns regarding the impact of antibiotics on breastfeeding efficacy, microbial health, and societal factors such as antimicrobial resistance. The prescription of antibiotics by a healthcare provider was a cue to action for women, as they trusted providers to recommend medications that were safe for them and their infants. Overall, mothers shared that receiving education on the effects of antibiotics would improve their self-efficacy and decision-making surrounding the use of antibiotics for treating illness. Implications for tailored perinatal health education interventions to enhance antibiotic use, knowledge, and decision-making are discussed.
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Affiliation(s)
- Lynn Y. Chen
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (L.Y.C.); (A.H.); (L.W.); (R.M.); (A.Y.); (M.F.); (E.S.)
| | - Elizabeth Flood-Grady
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA; (E.F.-G.); (J.L.K.)
- Clinical Translational Science Institute, University of Florida, Gainesville, FL 32611, USA
| | - Austen Hentschel
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (L.Y.C.); (A.H.); (L.W.); (R.M.); (A.Y.); (M.F.); (E.S.)
| | - Lauren Wright
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (L.Y.C.); (A.H.); (L.W.); (R.M.); (A.Y.); (M.F.); (E.S.)
| | - Rahma Mkuu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (L.Y.C.); (A.H.); (L.W.); (R.M.); (A.Y.); (M.F.); (E.S.)
- Clinical Translational Science Institute, University of Florida, Gainesville, FL 32611, USA
| | - Alyson Young
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (L.Y.C.); (A.H.); (L.W.); (R.M.); (A.Y.); (M.F.); (E.S.)
| | - Magda Francois
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (L.Y.C.); (A.H.); (L.W.); (R.M.); (A.Y.); (M.F.); (E.S.)
- Clinical Translational Science Institute, University of Florida, Gainesville, FL 32611, USA
| | - Josef Neu
- Department of Pediatrics, University of Florida Health, Gainesville, FL 32611, USA;
| | - Leslie A. Parker
- Department of Behavioral Nursing Science, University of Florida, Gainesville, FL 32611, USA;
| | - Elizabeth Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (L.Y.C.); (A.H.); (L.W.); (R.M.); (A.Y.); (M.F.); (E.S.)
- Clinical Translational Science Institute, University of Florida, Gainesville, FL 32611, USA
| | - Janice L. Krieger
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA; (E.F.-G.); (J.L.K.)
- Clinical Translational Science Institute, University of Florida, Gainesville, FL 32611, USA
| | - Dominick J. Lemas
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (L.Y.C.); (A.H.); (L.W.); (R.M.); (A.Y.); (M.F.); (E.S.)
- Clinical Translational Science Institute, University of Florida, Gainesville, FL 32611, USA
- Correspondence: ; Tel.: +352-294-5971
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