Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants.
Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants.
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DOI：
10.1542/peds.2007-3423
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发表时间：
2009-01
期刊：
影响因子：
8
通讯作者：
NICHD Neonatal Research Network
中科院分区：
文献类型：
--
作者：
Cotten CM;Taylor S;Stoll B;Goldberg RN;Hansen NI;Sánchez PJ;Ambalavanan N;Benjamin DK Jr;NICHD Neonatal Research Network
我们的目标是确定与出生后头3天开始的第一次抗生素疗程持续时间相关的因素，并评估初始抗生素疗程持续时间与随后极低出生体重儿的坏死性小肠结肠炎或死亡之间的关系，这些婴儿出生后最初的培养结果为无菌。我们对1998-2001年三级中心收治的极低出生体重儿进行了回顾性队列分析。我们将最初的经验性抗生素治疗持续时间定义为在出生后头3天开始抗生素治疗的连续天数，且有无菌培养结果。我们使用描述性统计来描述中心实践，使用双变量分析来确定与长期经验性抗生素治疗(≥5天)相关的因素，并使用多变量分析来评估治疗持续时间、经验性治疗时间延长和随后的坏死性小肠结肠炎或死亡之间的关联。在19个中心收治的5693名极低出生体重儿中，4039名(71%)存活了5天，接受了初步的经验性抗生素治疗，并在出生后3天内获得了无菌的初始培养结果。中位治疗时间为5天(范围1-36天)；2147名婴儿(53%)接受了延长的经验治疗(中心范围：27%-85%)。接受长期治疗的婴儿不太成熟，阿普加评分较低，更有可能是黑人。在调整了这些因素和中心的多变量分析中，延长治疗时间与坏死性小肠结肠炎或死亡的几率增加相关。每个经验性治疗日与死亡、坏死性小肠结肠炎以及坏死性小肠结肠炎或死亡的综合衡量标准增加相关。长时间的初始经验抗生素治疗可能与坏死性肠结肠炎或死亡的风险增加有关，应谨慎使用。
Our objectives were to identify factors associated with the duration of the first antibiotic course initiated in the first 3 postnatal days and to assess associations between the duration of the initial antibiotic course and subsequent necrotizing enterocolitis or death in extremely low birth weight infants with sterile initial postnatal culture results. We conducted a retrospective cohort analysis of extremely low birth weight infants admitted to tertiary centers in 1998–2001. We defined initial empirical antibiotic treatment duration as continuous days of antibiotic therapy started in the first 3 postnatal days with sterile culture results. We used descriptive statistics to characterize center practice, bivariate analyses to identify factors associated with prolonged empirical antibiotic therapy (≥5 days), and multivariate analyses to evaluate associations between therapy duration, prolonged empirical therapy, and subsequent necrotizing enterocolitis or death. Of 5693 extremely low birth weight infants admitted to 19 centers, 4039 (71%) survived >5 days, received initial empirical antibiotic treatment, and had sterile initial culture results through the first 3 postnatal days. The median therapy duration was 5 days (range: 1–36 days); 2147 infants (53%) received prolonged empirical therapy (center range: 27%–85%). Infants who received prolonged therapy were less mature, had lower Apgar scores, and were more likely to be black. In multivariate analyses adjusted for these factors and center, prolonged therapy was associated with increased odds of necrotizing enterocolitis or death and of death. Each empirical treatment day was associated with increased odds of death, necrotizing enterocolitis, and the composite measure of necrotizing enterocolitis or death. Prolonged initial empirical antibiotic therapy may be associated with increased risk of necrotizing entero-colitis or death and should be used with caution.
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DOI：
10.1136/fn.73.1.f32
发表时间：
1995-07-01
影响因子：
4.4
作者：
DECOURCYWHEELER, RHB;WOLFE, CDA;GAMSU, HR
通讯作者：
GAMSU, HR
影响因子：
4.9
作者：
PAPPUKATIKANENI, LD;RAO, KPP;BANISTER, E
通讯作者：
BANISTER, E
影响因子：
11.8
作者：
Rangel-Frausto, MS;Wiblin, T;Wenzel, RP
通讯作者：
Wenzel, RP
影响因子：
9.4
作者：
KURLAT, I;STOLL, BJ;MCGOWAN, JE
通讯作者：
MCGOWAN, JE
影响因子：
8
作者：
Clark, RH;Bloom, BT;Gerstmann, DR
通讯作者：
Gerstmann, DR