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. 2021 Feb;41(2):255-262.
doi: 10.1038/s41372-020-00784-y. Epub 2020 Aug 13.

Delivery-based criteria for empiric antibiotic administration among preterm infants

Samuel J Garber  1   2 , Miren B Dhudasia  1   3 , Dustin D Flannery  1   2   3 , Molly R Passarella  1 , Karen M Puopolo  1   2   3 , Sagori Mukhopadhyay  4   5   6
Affiliations

Delivery-based criteria for empiric antibiotic administration among preterm infants

Samuel J Garber et al. J Perinatol. 2021 Feb.

Abstract

Objective: Determine impact of using delivery criteria to initiate antibiotics among very low birth weight (VLBW) and extremely low birth weight (ELBW) infants. STUDY DESIGN: Single site cohort study from 01/01/2009 to 01/31/2020. After 04/2017, infants delivered by Cesarean section, without labor or membrane rupture were categorized as low-risk for early-onset infection and managed without empiric antibiotics. We determined effect of this guideline by pre-post, and interrupted time-series analyses.

Results: After 04/2017, antibiotic initiation ≤3 days decreased among low-risk VLBW (62% vs. 13%, p < 0.001) and low-risk ELBW (88% vs. 21%, p < 0.001) infants. In time series analysis, guideline was associated with decreased initiation among low-risk ELBW infants. In contrast, low-risk VLBW infants demonstrated decreased antibiotic initiation throughout study period. Incidence of confirmed infection, death, or transfer ≤7 days age was unchanged.

Conclusion: Delivery criteria may be used to optimize early antibiotic initiation among preterm infants without short-term increase in adverse outcomes.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors have no conflicts of interest relevant to this article to disclose.

Figures

Figure 1:
Figure 1:
Change in proportion of infants initiated on antibiotics ≤3 days after birth during study period. Panel A shows the changing average proportion of low-risk VLBW infants started on antibiotics over time and with guideline implementation. Panel B shows the changing average proportion of low-risk ELBW infants started on antibiotics over time and with guideline implementation. ELBW, extremely low birth weight (birth weight <1,000 grams); LCL, lower confidence limit; UCL, upper confidence limit; VLBW, very low birth weight (birth weight <1,500 grams).
Figure 1:
Figure 1:
Change in proportion of infants initiated on antibiotics ≤3 days after birth during study period. Panel A shows the changing average proportion of low-risk VLBW infants started on antibiotics over time and with guideline implementation. Panel B shows the changing average proportion of low-risk ELBW infants started on antibiotics over time and with guideline implementation. ELBW, extremely low birth weight (birth weight <1,000 grams); LCL, lower confidence limit; UCL, upper confidence limit; VLBW, very low birth weight (birth weight <1,500 grams).
See this image and copyright information in PMC

References

    1. Fouhy F, Guinane CM, Hussey S, Wall R, Ryan CA, Dempsey EM, et al. High-throughput sequencing reveals the incomplete, short-term recovery of infant gut microbiota following parenteral antibiotic treatment with ampicillin and gentamicin. Antimicrob Agents Chemother 2012. Nov;56(11):5811–5820. - PMC - PubMed
    1. Le J, Nguyen T, Okamoto M, McKamy S, Lieberman JM. Impact of empiric antibiotic use on development of infections caused by extended-spectrum beta-lactamase bacteria in a neonatal intensive care unit. Pediatr Infect Dis J 2008. Apr;27(4):314–318. - PubMed
    1. Ting JY, Roberts A, Sherlock R, Ojah C, Cieslak Z, Dunn M, et al. Duration of Initial Empirical Antibiotic Therapy and Outcomes in Very Low Birth Weight Infants. Pediatrics 2019 Mar;143(3):10.1542/peds.2018-2286. - DOI - PubMed
    1. Kuppala VS, Meinzen-Derr J, Morrow AL, Schibler KR. Prolonged initial empirical antibiotic treatment is associated with adverse outcomes in premature infants. J Pediatr 2011. Nov;159(5):720–725. - PMC - PubMed
    1. Ting JY, Synnes A, Roberts A, Deshpandey AC, Dow K, Yang J, et al. Association of Antibiotic Utilization and Neurodevelopmental Outcomes among Extremely Low Gestational Age Neonates without Proven Sepsis or Necrotizing Enterocolitis. Am J Perinatol 2018. Aug;35(10):972–978. - PubMed

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