Prolonged initial empirical antibiotic treatment is associated with adverse outcomes in premature infants.
Prolonged initial empirical antibiotic treatment is associated with adverse outcomes in premature infants.
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DOI：
10.1016/j.jpeds.2011.05.033
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发表时间：
2011-11
影响因子：
5.1
通讯作者：
Schibler, Kurt R.
中科院分区：
文献类型：
--
作者：
Kuppala, Venkata S.;Meinzen-Derr, Jareen;Morrow, Ardythe L.;Schibler, Kurt R.
旨在调查早产儿在出生后第一周长期经验性使用抗生素后的结果，得出随后的迟发性败血症 (LOS)、坏死性小肠结肠炎 (NEC) 和死亡。研究婴儿胎龄≤32周、出生体重≤1500克，且存活7天，没有败血症和NEC。进行多变量逻辑回归以确定长期初始经验性抗生素治疗（≥ 5 天）与控制出生体重、胎龄、种族、胎膜早破时间延长、7 天内高频通气天数以及生命前 14 天接受母乳量的研究结果之间的独立关系。在 365 名存活 7 天且没有脓毒症或 NEC 的早产儿中，36% 接受了长期的初始经验性抗生素治疗，这与随后的结果独立相关：LOS（比值比 [OR] 2.45，95% 置信区间 [CI] 1.28–4.67）以及 LOS、NEC 或死亡的组合（OR 2.66，95% CI 1.12–6.3）。在生命第一周内对培养物无菌的早产儿长期使用经验性抗生素与随后的严重后果相关。应研究明智地限制抗生素的使用，作为减少早产儿严重后果的策略。
To investigate the outcomes following prolonged empirical antibiotic administration to premature infants in the first week of life, concluding subsequent late onset sepsis (LOS), necrotizing enterocolitis (NEC), and death. Study infants were ≤32 weeks gestational age and ≤ 1500 grams birth weight who survived free of sepsis and NEC for 7 days. Multivariable logistic regression was conducted to determine independent relationships between prolonged initial empirical antibiotic therapy (≥ 5 days) and study outcomes controlling for birth weight, gestational age, race, prolonged premature rupture of membranes, days on high frequency ventilation in 7 days, and the amount of breast milk received in the first 14 days of life. Of the 365 premature infants surviving 7 days free of sepsis or NEC, 36% received prolonged initial empirical antibiotics, which was independently associated with subsequent outcomes: LOS (odds ratio [OR] 2.45, 95% confidence interval [CI] 1.28–4.67) and the combination of LOS, NEC, or death (OR 2.66, 95% CI 1.12–6.3). Prolonged administration of empirical antibiotics to premature infants with sterile cultures in the first week of life is associated with subsequent severe outcomes. Judicious restriction of antibiotic use should be investigated as a strategy to reduce severe outcomes for premature infants.
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