Antibiotic exposure for culture-negative early-onset sepsis in late-preterm and term newborns: an international study.

Autor: Dimopoulou V; Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. varvara.dimopoulou@chuv.ch., Klingenberg C; Research Group for Child and Adolescent Health, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.; Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway., Navér L; Department of Neonatology, Karolinska University Hospital and Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden., Nordberg V; Department of Neonatology, Karolinska University Hospital and Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden., Berardi A; Neonatal Intensive Care Unit, Mother and Child Department, Policlinico University Hospital, Modena, Italy., El Helou S; Division of Neonatology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, ON, Canada., Fusch G; Division of Neonatology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, ON, Canada., Bliss JM; Division of Neonatology, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA., Lehnick D; Biostatistics and Methodology, CTU-CS, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland., Guerina N; Department of Pediatrics, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI, USA., Seliga-Siwecka J; Department of Neonatology and Neonatal Intensive Care, Medical University of Warsaw, Warsaw, Poland., Maton P; Neonatal Service, CHC-Montlegia Clinic, CHC Health Group, Liège, Belgium., Lagae D; Neonatology and Neonatal Intensive Care Unit, CHIREC-Delta Hospital, Brussels, Belgium., Mari J; Department of Paediatrics, University of Szeged, Szeged, Hungary., Janota J; Neonatal Unit, Department of Obstetrics and Gynecology, Motol University Hospital Prague, Prague, Czech Republic.; Department of Pathological Physiology, 1st Medical School, Charles University Prague, Prague, Czech Republic.; Department of Neonatology, Thomayer University Hospital Prague, Prague, Czech Republic., Agyeman PKA; Division of Pediatric Infectious Disease, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Pfister R; Neonatology and Paediatric Intensive Care Unit, Geneva University Hospitals and Geneva University, Geneva, Switzerland., Latorre G; Neonatology and Neonatal Intensive Care Unit, Ecclesiastical General Hospital F. Miulli, Acquaviva delle Fonti, Italy., Maffei G; Neonatology and Neonatal Intensive Care Unit, Policlinico Riuniti Foggia, Foggia, Italy., Laforgia N; Neonatology and Neonatal Intensive Care Unit, University of Bari, Bari, Italy., Mózes E; Perinatal Intensive Care Unit, Department of Obstetrics and Gynaecology, Semmelweis University, Budapest, Hungary., Størdal K; Department of Pediatric Research, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway., Strunk T; Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, WA, Australia., Stocker M; Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland., Giannoni E; Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. eric.giannoni@chuv.ch.
Jazyk: angličtina
Zdroj: Pediatric research [Pediatr Res] 2024 Sep 17. Date of Electronic Publication: 2024 Sep 17.
DOI: 10.1038/s41390-024-03532-6
Abstrakt: Background: Early-life antibiotic exposure is disproportionately high compared to the burden of culture-proven early-onset sepsis (CP-EOS). We assessed the contribution of culture-negative cases to the overall antibiotic exposure in the first postnatal week.
Methods: We conducted a retrospective analysis across eleven countries in Europe, North America, and Australia. All late-preterm and term infants born between 2014 and 2018 who received intravenous antibiotics during the first postnatal week were classified as culture-negative cases treated for ≥5 days (CN ≥ 5d), culture-negative cases treated for <5 days (CN < 5d), or CP-EOS cases.
Results: Out of 757,979 infants, 21,703 (2.9%) received intravenous antibiotics. The number of infants classified as CN ≥ 5d, CN < 5d, and CP-EOS was 7996 (37%), 13,330 (61%), and 375 (1.7%). The incidence of CN ≥ 5d, CN < 5d, and CP-EOS was 10.6 (95% CI 10.3-10.8), 17.6 (95% CI 17.3-17.9), and 0.49 (95% CI 0.44-0.54) cases per 1000 livebirths. The median (IQR) number of antibiotic days administered for CN ≥ 5d, CN < 5d, and CP-EOS was 77 (77-78), 53 (52-53), and 5 (5-5) per 1000 livebirths.
Conclusions: CN ≥ 5d substantially contributed to the overall antibiotic exposure, and was 21-fold more frequent than CP-EOS. Antimicrobial stewardship programs should focus on shortening antibiotic treatment for culture-negative cases.
Impact: In a study of 757,979 infants born in high-income countries, we report a presumed culture-negative early-onset sepsis incidence of 10.6/1000 livebirths with an associated antibiotic exposure of 77 antibiotic days per 1000 livebirths. This study sheds light on the major contribution of presumed culture-negative early-onset sepsis to early-life antibiotic exposure. Given the diagnostic uncertainty surrounding culture-negative early-onset sepsis, the low mortality rate, and the disproportionate antibiotic exposure associated with this condition, our study emphasizes the importance of targeting culture-negative early-onset sepsis in antimicrobial stewardship programs.
Competing Interests: Competing interests: Alberto Berardi reported receiving personal fees from Atheneum Partners, GmbH outside the submitted work. Joseph M. Bliss reported receiving personal fees from Mead Johnson Nutrition outside the submitted work. No other disclosures were reported.
(© 2024. The Author(s).)
Databáze: MEDLINE
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