Prolonged Duration of Initial Empirical Antibiotic Treatment Is Associated With Increased Rates of Necrotizing Enterocolitis and Death for Extremely Low Birth Weight Infants
By C. Cotten, Sarah Taylor, B. Stoll, R. Goldberg, N. Hansen, P. Sánchez, N. Ambalavanan, Daniel K. Benjamin. Pediatrics, 2009
946 citations recorded by the source corpus.
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. CONCLUSION. Prolonged initial empirical antibiotic therapy may be associated with increased risk of necrotizing enterocolitis or death and should be used with caution.
Subfields: Epidemiology, Nutrition and Dietetics, Public Health, Environmental and Occupational Health
View Paper: https://www.semanticscholar.org/paper/a979897103864c4a8f8845363645e76273fe6193
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In Nutrition and Dietetics
Citations in the corpus
- Prolonged Initial Empirical Antibiotic Treatment is Associated with Adverse Outcomes in Premature Infants (2011, background): “Cotten et al reported that 53% of the 4039 ELBW infant enrolled in the NICHD NRN between 1998 and 2001 received initial empirical antibiotic therapy for ≥ 5 days duration despite sterile blood cultures(8).”
- Impact of antibiotics on the human microbiome and consequences for host health (2022, background): “NEC and AAD have also been associated with prolonged or prophylactic antibiotic uptake in early life (Alexander et al., 2011; Kuppala et al., 2011; Michael Cotten et al., 2009).”
- Probiotics and the gut microbiota in intestinal health and disease (2010, background): “A retrospective study of very low birth weight premature infants showed that prolonged antibiotic treatment in the first days of life increases the risk of developing necrotizing enterocolitis and subsequent death”