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Early empiric antibiotic exposure affects gut microbiota development of very preterm infants

Aranka J van Wesemael1,2,3, Kelly Klomp4, Anna M Malinowska4

  • 1Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, the Netherlands.

Pediatric Research
|February 17, 2026
PubMed

Insights

Early antibiotic exposure in preterm infants alters gut microbiota diversity and composition. Reducing antibiotic use for suspected early-onset sepsis can protect the developing gut microbiome.

Area of Science:

  • Microbiome research
  • Neonatal medicine
  • Pediatric infectious diseases

Background:

  • Preterm infants often receive antibiotics for suspected early-onset sepsis (EOS).
  • Early empiric antibiotic exposure (EEAE) may negatively impact the gut microbiota development in these vulnerable infants.
  • Understanding the relationship between EEAE duration and gut microbiota dynamics is crucial for optimizing neonatal care.

Purpose of the Study:

  • To investigate the association between the duration of early empiric antibiotic exposure (EEAE) and gut microbiota composition in very preterm infants.
  • To analyze how different durations of EEAE influence microbial diversity and taxonomic profiles within the first month of life.

Main Methods:

  • A cohort of 127 very preterm infants (<30 weeks gestation) with limited antibiotic exposure was studied.
  • Infants were stratified into non-exposed, short EEAE (48-96h), and long EEAE (96-192h) groups.
  • Fecal samples were collected weekly for the first month and analyzed using 16S rRNA gene sequencing.

Main Results:

  • EEAE duration correlated with increased gut microbiota alpha-diversity over the first month.
  • Specific bacteria, including Veillonella and Enterococcus, were found in lower abundance in infants with EEAE.
  • A distinct Staphylococcus community type was more prevalent in infants exposed to EEAE, regardless of duration.

Conclusions:

  • Both short and long durations of EEAE significantly alter the preterm infant gut microbiota.
  • Impacts include changes in microbial diversity, taxonomic composition, and the prevalence of specific community types.
  • Findings highlight the need to judiciously manage antibiotic use for suspected EOS to preserve the developing gut microbiome.
Abstract

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