Prolonged Duration of Initial Empirical Antibiotic Treatment Is Associated With Increased Rates of Necrotizing Enterocolitis and Death for Extremely Low Birth Weight Infants

Abstract

OBJECTIVES-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.METHODS-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.RESULTS-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. Copyright © 2009 by the American Academy of PediatricsAddress correspondence to C. Michael Cotten, MD, MHS, PO Box 3179, Duke University, Durham, NC 27710. E-mail: cotte010@mc.duke.edu. The authors have indicated they have no financial relationships relevant to this article to disclose.Reprints Information about ordering reprints can be found online: http://www.pediatrics.org/misc/reprints.shtml NIH Public Access Author ManuscriptPediatrics. Author manuscript; available in PMC 2010 January 1. Published in final edited form as:Pediatrics. Antibiotics are the most commonly prescribed medications in intensive care nurseries. 1,2 Virtually all extremely low birth weight (ELBW) infants (birth weight of <1000 g) admitted to intensive care nurseries receive empirical antibiotic treatment in the first postnatal days, although cultures from normally sterile sites usually do not yield any bacterial agents and the incidence of culture-proven bacterial sepsis is low in this population. 2,3 A previous study suggested that selection of cefotaxime instead of gentamycin for the first 3 postnatal days was associated with higher mortality risk, even for the most preterm infants. 2 In addition to selecting which antibiotics to use for initial th...

Estrategias para reducir infecciones, uso de antimicrobianos y sus efectos en una unidad de neonatología

“…Antimicrobianos meros días de vida y un aumento de la morbi-mortalidad, sepsis tardía y enterocolitis necrosante [9][10][11] .…”

Implementation of an Antimicrobial Stewardship Program in a Neonatal Intensive Care Unit

“…3,4 While timely interventions for a true infection are critical, repeated and unnecessary exposures to broad-spectrum antibiotics can result in the development of antimicrobial resistance among certain organisms, as well as an increased risk of candidemia, necrotizing enterocolitis (NEC), hospital-acquired infections, and death in preterm infants. [5][6][7][8][9][10][11][12][13] Organizations have published guidelines aimed at improving antibiotic prescription practices of healthcare providers and, based on these guidelines, some children's hospitals have successfully implemented antimicrobial stewardship programs (ASPs). [14][15][16][17][18][19][20] Information on the design and implementation of NICU-specific ASPs, however, remains extremely limited.…”

Metrics for NICU antibiotic use: which rate is right?

“…14 Treatment of culture negative early onset sepsis is associated with the development of necrotizing enterocolitis. 15 Thus, appropriate antibiotic use, which rate is right, could be measured both quantitatively and qualitatively.…”