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A Murine Model of Fetal Exposure to Maternal Inflammation to Study the Effects of Acute Chorioamnionitis on Newborn Intestinal Development
Published on: June 24, 2020
Invasive fungal infection is associated with antibiotic exposure in preterm infants: a multi-centre prospective
1Department of Paediatrics, Yantai Yuhuangding Hospital, Yantai, Shandong, China.
Background:
Previous antibiotic exposure is an important risk factor for invasive fungal infection (IFI). Antibiotic overexposure is common in lower-income countries; however, multi-centre studies concerning IFI in relation to antibiotic exposure are scarce.
Aim:
This prospective, multi-centre matched case-control study explored the correlation of IFI and antibiotic exposure in very preterm infants or very-low-birthweight infants admitted to 23 tertiary hospitals in China between 2018 and 2021.
Methods:
Using a 1:2 matched design for gestational age, birth weight and early-onset sepsis (yes/no), the risk factors between infants diagnosed with IFI and infection-free controls were compared. The antibiotic use rate (AUR) was calculated using calendar days of antibiotic therapy in the 4 weeks preceding IFI onset divided by onset day of IFI.
Findings:
In total, 6368 infants were included in the study, of which 90 (1.4%) were diagnosed with IFI. Median AUR, length of antibiotic therapy (LOT) and days of antibiotic therapy (DOT) within the 4 weeks preceding IFI onset were 0.90, 18 days and 30 days, respectively. Multi-variate analysis showed that a 10% increase in AUR, each additional day of DOT and LOT, and each additional day of third-generation cephalosporins and carbapenems were notably associated with IFI.
Conclusion:
Prolonged antibiotic therapy is common before the onset of IFI, and is an important risk factor, especially the use of third-generation cephalosporins and carbapenems. Antibiotic stewardship should be urgently developed and promoted for preterm infants in order to reduce IFI in lower-income countries such as China.
Insights
Prolonged antibiotic exposure, particularly third-generation cephalosporins and carbapenems, significantly increases the risk of invasive fungal infections (IFI) in preterm infants. Antibiotic stewardship is crucial for reducing IFI in lower-income countries.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Previous antibiotic exposure is a known risk factor for invasive fungal infections (IFI).
- Antibiotic overexposure is prevalent in lower-income countries, yet multi-center studies on IFI and antibiotic exposure are limited.
- This study addresses the scarcity of research on IFI risk factors in relation to antibiotic use among vulnerable infant populations in China.
Purpose of the Study:
- To investigate the correlation between antibiotic exposure and invasive fungal infections (IFI) in very preterm or very-low-birthweight infants.
- To identify specific antibiotic classes and duration of therapy associated with increased IFI risk.
- To inform the development of antibiotic stewardship programs in neonatal intensive care units.
Main Methods:
- A prospective, multi-center matched case-control study involving 23 tertiary hospitals in China (2018-2021).
- Infants were matched 1:2 for gestational age, birth weight, and early-onset sepsis status.
- Antibiotic Use Rate (AUR), Length of Therapy (LOT), and Days of Therapy (DOT) were calculated in the 4 weeks preceding IFI onset.
Main Results:
- Out of 6368 infants, 90 (1.4%) developed IFI.
- Median AUR was 0.90, with median LOT of 18 days and DOT of 30 days prior to IFI onset.
- Increased AUR, longer DOT and LOT, and use of third-generation cephalosporins and carbapenems were significantly associated with IFI risk.
Conclusions:
- Prolonged antibiotic therapy is a significant risk factor for IFI in preterm infants.
- Specific antibiotics, including third-generation cephalosporins and carbapenems, are particularly implicated.
- Urgent development and promotion of antibiotic stewardship are recommended to mitigate IFI in lower-income settings like China.
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