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Published on: August 30, 2018
Prolonged empirical antibiotic therapy despite negative blood cultures in neonates: a retrospective
Fitim Alidema1, Arieta Hasani Alidema2, Lirim Mustafa3
1Dept. of Pharmacology, Faculty of Pharmacy, UBT College, Prishtina, Kosovo.
Insights
Prolonged empirical antibiotic use in neonates with negative cultures is common. Prematurity, low birth weight, and clinical severity are key predictors, highlighting the need for antimicrobial stewardship.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Antimicrobial Stewardship
Background:
- Empirical antibiotic therapy is standard for suspected neonatal sepsis.
- Continuation despite negative blood cultures poses an antimicrobial stewardship challenge.
- Early-life antibiotic exposure may increase risks of adverse outcomes and resistance.
Purpose of the Study:
- To determine the prevalence of prolonged empirical antibiotic therapy in neonates with negative blood cultures.
- To identify independent predictors of this prolonged therapy over a three-year period.
Main Methods:
- Retrospective cohort study of 550 neonates (Jan 2023-Jan 2026).
- Analysis of clinical data, lab parameters (CRP, WBC, procalcitonin), gestational age, birth weight, and antibiotic regimens (WHO AWaRe).
- Prolonged therapy defined as >5 days despite negative cultures; multivariable logistic regression used to find predictors.
Main Results:
- 82.4% of neonates had negative blood cultures.
- 41.8% of these received antibiotics for >5 days (mean 6.7 days).
- Predictors included prematurity (<37 weeks), very low birth weight (<1500g), elevated CRP, and mechanical ventilation.
Conclusions:
- Prolonged empirical antibiotic therapy in neonates with negative cultures is frequent.
- Associated with prematurity, low birth weight, inflammatory markers, and clinical severity.
- Targeted antimicrobial stewardship interventions are needed to optimize antibiotic use.
Background:
Empirical antibiotic therapy is routinely initiated in neonatal units for suspected sepsis; however, continuation of treatment despite negative blood cultures represents a major antimicrobial stewardship challenge. Prolonged exposure in early life may increase the risk of adverse outcomes and antimicrobial resistance.
Objectives:
To evaluate the prevalence and independent predictors of prolonged empirical antibiotic therapy in neonates with negative blood cultures over a three-year period.
Methods:
This retrospective cohort study included 550 neonates treated with empirical antibiotics between January 2023 and January 2026. Clinical data, laboratory parameters (C-reactive protein, white blood cell count, procalcitonin), gestational age, birth weight, indication for therapy, blood culture results, and antibiotic regimens classified according to the WHO AWaRe framework were analyzed. Prolonged therapy was defined as antibiotic treatment exceeding five days despite negative cultures. Days of therapy (DOT) and DOT per 1000 patient-days were calculated. Multivariable logistic regression identified independent predictors.
Results:
Blood cultures were negative in 82.4% of neonates. Among these, 41.8% received antibiotics for more than five days. The mean duration of therapy was 6.7 ± 2.4 days, and DOT reached 724 per 1000 patient-days. Prematurity (< 37 weeks) was independently associated with prolonged therapy (OR 2.36; 95% CI 1.58-3.52; p < 0.001), particularly < 32 weeks (OR 3.41; 95% CI 2.01-5.79; p < 0.001). Birth weight < 1500 g (OR 2.87; 95% CI 1.74-4.72; p < 0.001), elevated CRP (> 20 mg/L) (OR 1.94; 95% CI 1.29-2.91; p = 0.002), and mechanical ventilation (OR 2.11; 95% CI 1.32-3.37; p = 0.001) were significant predictors. "Watch" antibiotics accounted for 38.6% of initial regimens.
Conclusions:
Prolonged empirical antibiotic therapy despite negative blood cultures remains frequent in neonatal practice and is independently associated with prematurity, very low birth weight, inflammatory markers, and clinical severity. Targeted antimicrobial stewardship interventions are warranted to optimize neonatal antibiotic use.
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