Prolonged use of antibiotics after birth is associated with increased morbidity in preterm infants with negative cultures
Prolonged use of antibiotics after birth is associated with increased morbidity in preterm infants with negative cultures
复制标题
DOI：
10.1080/14767058.2018.1481042
复制
发表时间：
2019-12-17
影响因子：
1.8
通讯作者：
Harabor, Andrei
中科院分区：
文献类型：
--
作者：
Fajardo, Carlos;Alshaikh, Belal;Harabor, Andrei
背景：尽管培养结果为阴性，大多数早产儿在出生后仍会接受不同持续时间的抗生素治疗。有关长期使用抗生素的风险的数据正在浮出水面。我们试图评估单一大型围产期中心队列中初始抗生素疗程长短与新生儿结局之间的关系。方法：回顾性队列研究前瞻性收集的资料，所有出生体重小于1250g的新生儿在4年内在NICU住院，出生后头2天血和脑脊液培养阴性。主要结果是坏死性小肠结肠炎(NEC)、迟发性脓毒症(LOS)和死亡的组合，使用多变量回归分析进行评估。结果：在4年的时间里，共有620名培养阴性的小于1250克的婴儿符合研究条件。首次使用抗生素超过5天的238名婴儿比接受5天抗生素治疗的382名婴儿明显更小，胎龄更低。她们的母亲有更多的临床绒毛膜羊膜炎，较少的母亲高血压和围产期使用更多的抗生素。多因素分析显示，在调整了胎龄、SNAP II、小于胎龄、性别、母亲高血压、产前激素治疗、临床绒毛膜羊膜炎、产中抗生素治疗和多胎后，使用经验性抗生素5天以上的婴儿新生儿发病率较高。综合结果OR：1.83(1.15~2.92)，LOS OR：2.02(1.20~3.39)，支气管肺发育不良OR：1.58(1.04~2.29)。死亡率和NEC无显著差异。结论：在培养阴性的早产儿中，超过5天的抗生素治疗与我们人群中发病率的增加有关，包括BPD。值得注意的是，不同研究的发病率和/或死亡率增加的模式不同。在早产儿中启动和停止抗生素的临床方案的前瞻性试验是必要的。
Background: Most preterm infants are exposed to a variable duration of antibiotic therapy after birth despite negative cultures. Data is emerging about the risks of prolonged antibiotics. We sought to assess the association between length of initial antibiotic course and neonatal outcomes in a cohort from a single large perinatal center. Methods: Retrospective cohort study of prospectively collected data on all infants with a birth weight of less than 1250 g hospitalized in our NICU in a 4 year window and who had negative blood and CSF cultures in the first 2 days of life. The primary outcome is a composite of necrotizing enterocolitis (NEC), late onset sepsis (LOS) and death evaluated using multivariable regression analysis. Results: A total of 620 infants less than 1250 g with negative cultures were eligible for study over a 4 year period. The 238 infants with more than 5 days initial antibiotic use were significantly smaller and of lower gestational age than the 382 infants who received up to 5 days of antibiotics. Their mothers had more clinical chorioamnionitis, less maternal hypertension and greater perinatal use of antibiotics. On multivariate analysis, infants who received empiric antibiotics for longer than 5 days had higher rates of neonatal morbidities after adjusting for gestational age, SNAP II, small-for-gestational age status, gender, maternal hypertension, prenatal steroid treatment, clinical chorioamnionitis, intrapartum antibiotic treatment, and multiple births. Composite outcome OR: 1.83 (1.15 to 2.92), LOS OR: 2.02 (1.20 to 3.39), bronchopulmonary dysplasia OR: 1.58 (1.04 to 2.29). Mortality and NEC were not significantly different. Conclusion: More than 5 days of antibiotic treatment in very preterm infants with negative cultures was associated with increased morbidity in our population, and that included BPD. It is of note that patterns of increased morbidity and/or mortality differ between studies. Prospective trials of clinical protocols for starting and stopping antibiotics in the very preterm infants are required.