Impact of early antibiotic exposure on the risk of colonization with potential pathogens in very preterm infants: a retrospective cohort analysis

Abstract

Background Sepsis is one of the most important complications in preterm infants. For this reason, most preterm infants receive antibiotics during their first postnatal week. Since 2013, a weekly colonization screening has been installed in German neonatal intensive care units (NICUs), including multi-drug resistant organisms (MDRO) and pathogens with increased epidemic potential. We here investigated the impact of early antibiotic exposure on the colonization with these pathogens. Methods Data from 1407 preterm infants with gestational age < 32 + 0 weeks and born in three NICUs in Germany between January 2014 and December 2019 were analysed. Results Antibiotics were administered to 911/1407 (64.7%) participating infants during their first postnatal week. Screening-targeted pathogens were detected in 547/1407 (38.9%). Early antibiotic exposure did not increase the risk of colonization with screening-targeted pathogens. The only independent risk factor for colonisation with potential pathogens was the admitting hospital. Interestingly, longer antibiotic therapy (> 7 days) decreased the risk for acquiring pathogens with increased epidemic potential. Conclusion Early antibiotic exposure did not impact the risk for colonization with MDRO or highly epidemic pathogens in preterm infants. Further studies are needed to identify risk factors for the acquisition of MDRO and highly epidemic pathogens and potential associations with long-term outcome.

Early initiation of antibiotic therapy and short-term outcomes in preterm infants: a single-centre retrospective cohort analysis

“…We found high rates of antibiotic treatment in our cohort with about 70% of all VLBWI exposed to antibiotics during their initial hospital stay and about 55% already exposed within the first 2 days of postnatal life. This is in line with previous reports showing rates up 80% of VLWBI receiving early antibiotics 6 7 26. However, the extremely high number of antibiotic-exposed infants within the first 2 days of postnatal life contrasts sharply with the reported incidence of culture-proven EOS of 1%–2%1 27 28 and the actual incidence of EOS in our cohort (clinical and culture-proven EOS amounting to 6.1%).…”

“…In addition to high mortality, neonatal sepsis is associated with a wide variety of severe complications during the neonatal period, such as bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), intraventricular haemorrhage (IVH) or necrotising enterocolitis (NEC), as well as poor neurodevelopmental outcome 1 5. For this reason, up to 90% of extremely premature infants receive antibiotics early after birth 6 7…”

Early antibiotics and risk for necrotizing enterocolitis in premature infants: A narrative review

“…This limitation was demonstrated in the study by Boyle et al ( 17 ) where infants prophylactically treated with kanamycin had higher incidence of kanamycin-resistant enteric gram-negative bacteria compared to controls. A second limitation is selective growth of other pathogenic bacteria ( 26 ). This limitation was demonstrated in the study by Siu et.…”

Association between indoor environmental risk factors and pneumonia among preschool children in Urumqi：A case-control study

“…This could be related to the impact of the gut microbiome on the development of the immune system, thereby affecting children's resistance to respiratory infections. However, research by Bubser et al [ 17 ] found that early antibiotic treatment did not increase the risk of carrying potential pathogens in preterm infants. Yet, research by Chen et al [ 18 ] points out that early antibiotic exposure is associated with an increased risk of bronchopulmonary dysplasia in very low birth weight infants.…”