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Determinants of Prolonged Antibiotic Administration in Culture-Negative Evaluations of Early-Onset Neonatal

Rowan Mesilhy1, Ibrahim Safra2, Shaikha Alnaimi3

  • 1Department of Internal Medicine, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar.

Antibiotics (Basel, Switzerland)
|September 27, 2025
PubMed

Insights

Prolonged antibiotic use is common in neonates with suspected early-onset neonatal meningitis (EONM) but negative CSF cultures. Clinical factors like low Apgar scores and positive blood cultures predict longer treatment, guiding antimicrobial stewardship.

Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Early-onset neonatal meningitis (EONM) often leads to prolonged antibiotic treatment, even with sterile cerebrospinal fluid (CSF) cultures.
  • The rationale behind extended antibiotic use in these cases remains unclear.

Purpose of the Study:

  • To identify determinants of prolonged antibiotic therapy in neonates with sterile CSF cultures during the first week of life.
  • To inform risk-stratified treatment decisions and improve antimicrobial stewardship.

Main Methods:

  • Retrospective analysis of 315 neonates born between 2015-2018 with sterile CSF cultures.
  • Evaluation of clinical and laboratory factors associated with prolonged antibiotic use.

Main Results:

  • 30.5% of neonates received prolonged antibiotics.
  • Predictors included lower birth weight, gestational age, respiratory support, illness severity, neutropenia, positive blood cultures, elevated C-reactive protein (CRP), and CSF abnormalities.
  • Independent predictors for prolonged antibiotic use were low Apgar scores, positive blood cultures, traumatic lumbar puncture (LP), high CRP, delayed LP, and elevated CSF white cell counts.

Conclusions:

  • Prolonged antibiotic use in neonates with suspected EONS and sterile CSF is frequent.
  • Clinical and laboratory indicators of illness severity and inflammation are key drivers.
  • Identifying these predictors can optimize antimicrobial use and patient care.
Keywords:
C-reactive protein, CRPcerebrospinal fluid, CSFneonatal meningitisprolonged antibiotic therapysepsis

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