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Prolonged initial empirical antibiotic treatment is associated with adverse outcomes in premature infants

Venkata S Kuppala1, Jareen Meinzen-Derr, Ardythe L Morrow

  • 1Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

The Journal of Pediatrics
|July 26, 2011
PubMed

Insights

Prolonged antibiotic use in premature infants is linked to increased risks of late-onset sepsis (LOS), necrotizing enterocolitis (NEC), and death. Restricting antibiotic exposure may improve outcomes for these vulnerable infants.

Area of Science:

  • Neonatal Medicine
  • Pediatric Infectious Diseases
  • Clinical Pharmacology

Background:

  • Premature infants are susceptible to infections.
  • Early antibiotic use is common but may have adverse effects.

Purpose of the Study:

  • To examine the association between prolonged empirical antibiotic therapy in the first week of life and subsequent outcomes in premature infants.
  • To identify risks of late-onset sepsis (LOS), necrotizing enterocolitis (NEC), and death.

Main Methods:

  • Retrospective analysis of premature infants (≤ 32 weeks GA, ≤ 1500 g BW) surviving 7 days without sepsis or NEC.
  • Multivariable logistic regression to assess the impact of prolonged antibiotic therapy (≥ 5 days) on outcomes, controlling for confounding factors.

Main Results:

  • 36% of eligible infants received prolonged empirical antibiotics.
  • Prolonged antibiotic use was independently associated with increased risk of LOS (OR 2.45) and combined LOS, NEC, or death (OR 2.66).

Conclusions:

  • Prolonged empirical antibiotic administration in premature infants with negative cultures is associated with severe adverse outcomes.
  • Restricting antibiotic use warrants investigation as a strategy to improve outcomes in premature infants.
Abstract

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