Antibiotic exposure in culture-negative preterm infants: a 10-year single-centre study

Area of Science:

• Neonatal Medicine
• Pediatric Pharmacology
• Infectious Disease Epidemiology

Background:

• Antibiotic use is prevalent in neonatal intensive care units (NICUs).
• Very preterm infants (<32 weeks' gestation) are particularly vulnerable to antibiotic-associated morbidities.
• Understanding the impact of antibiotic exposure duration on outcomes in culture-negative infants is crucial.

Purpose of the Study:

• To describe antibiotic utilization patterns in very preterm infants.
• To investigate the association between antibiotic exposure duration and neonatal outcomes in blood culture-negative infants.

Main Methods:

• Retrospective cohort study of infants <32 weeks' gestation (2012-2022).
• Antibiotic exposure quantified by duration of treatment (DOT) and antibiotic utilization rate (AUR).
• Outcomes assessed included mortality, late-onset sepsis (LOS), necrotizing enterocolitis (NEC), chronic lung disease (CLD), severe retinopathy of prematurity (ROP), and severe brain injury.

Main Results:

• 3235 culture-negative infants were analyzed; 26% received antibiotics for ≥5 days.
• Antibiotic utilization rate (AUR) and duration of treatment (DOT) decreased over the study period.
• Prolonged antibiotic exposure was significantly associated with increased mortality, brain injury, NEC, ROP, LOS, and CLD.

Conclusions:

• Prolonged antibiotic exposure is frequent in culture-negative, very preterm infants.
• While critical for culture-positive sepsis, antibiotics can harm culture-negative infants.
• Findings necessitate strategies to reduce antibiotic exposure and improve outcomes in this vulnerable population.