Anaerobic Antimicrobial Therapy After Necrotizing Enterocolitis in VLBW Infants

Abstract

OBJECTIVE: To evaluate the effect of anaerobic antimicrobial therapy for necrotizing enterocolitis (NEC) on clinical outcomes in very low birth weight (≤1500 g) infants. METHODS: We identified very low birth weight infants with NEC from 348 US NICUs from 1997 to 2012. Anaerobic antimicrobial therapy was defined by antibiotic exposure on the first day of NEC. We matched (1:1) infants exposed to anaerobic antimicrobial therapy with infants who were not exposed by using a propensity score stratified by NEC severity (medical and surgical). The primary composite outcome was in-hospital death or intestinal stricture. We assessed the relationship between anaerobic antimicrobial therapy and outcome by using a conditional logistic regression on the matched cohort. RESULTS: A total of 1390 infants exposed to anaerobic antimicrobial therapy were matched with 1390 infants not exposed. Mean gestational age and birth weight were 27 weeks and 946 g, respectively, and were similar in both groups. We found no significant difference in the combined outcome of death or strictures, but strictures as a single outcome were more common in the anaerobic antimicrobial therapy group (odds ratio 1.73; 95% confidence interval, 1.11–2.72). Among infants with surgical NEC, mortality was less common with anaerobic antimicrobial therapy (odds ratio 0.71; 95% confidence interval, 0.52–0.95). CONCLUSIONS: Anaerobic antimicrobial therapy was not associated with the composite outcome of death or strictures but was associated with an increase in intestinal strictures. This higher incidence of intestinal strictures may be explained by the fact that death is a competing outcome for intestinal strictures, and mortality was slightly lower in the anaerobic cohort. Infants with surgical NEC who received anaerobic antimicrobial therapy had lower mortality.

Gastrointestinal sequelae after surgery for necrotising enterocolitis: a systematic review and meta-analysis

“…We excluded several studies from our meta-analysis due to overlapping study populations 2 12–16. Some studies17–25 showed partially overlapping study populations with Autmizguine et al ,26 however described different GI outcomes. Thyoka et al published two studies with a largely overlapping study population, but reported different outcomes 27 28.…”

“…Thyoka et al published two studies with a largely overlapping study population, but reported different outcomes 27 28. The studies of Hall et al /Thyoka et al 28 29 and Autmizguine et al /O’Connor and Sawin18 26 showed only a small partial overlap and provided mostly unique information. Therefore, we included all four studies (see online supplementary appendix D).…”

“…Table 1 lists the study characteristics, reported sequelae and interventions performed. The eligible articles described a total of 4260 patients undergoing surgical intervention for NEC, of whom 2996 (70%) survived the acute phase 2 12 13 15–69. Most patient cohorts were small (surgical NEC median 44 patients per study, range 7–706, see table 2).…”

“…Of 34 studies which explicitly reported strictures,2 12 13 15 16 18 26 28–38 41–55 69 seven studies were not included in the meta-analysis. Strictures occurred in 24% (95% CI 17% to 31%).…”

Necrotizing Enterocolitis: A Narrative Review of Updated Therapeutic and Preventive Interventions

“…-Gram-negatives and anaerobes) plus or minus the administration of an anti-fungal agent is accepted. Autmizguine et al (18) showed that administration of an anaerobic antimicrobial medication resulted in increased incidence of stricture formation, possibly due to the reduced mortality when compared to the control group. There was no difference in death between the exposed and non-exposed groups.…”