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The impact of early empirical antibiotics treatment on clinical outcome of very preterm infants: a nationwide multicentre study in China
BACKGROUND: Infants with rule-out infections are responsible for the majority of empirical antibiotics treatment (EAT) in neonatal intensive care units (NICUs), particularly very preterm infants (VPIs). Antibiotic overuse has been linked to adverse outcomes. There is a paucity of data on the associa...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2023
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9878784/ https://www.ncbi.nlm.nih.gov/pubmed/36698176 http://dx.doi.org/10.1186/s13052-023-01414-x |
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author | Zhu, Yao Yang, Qing Wu, Fan Mao, Jian Liu, Ling Zhang, Rong Shen, Wei Tang, Lixia Chang, Yanmei Ye, Xiuzhen Qiu, Yinping Ma, Li Cheng, Rui Wu, Hui Chen, Dongmei Zheng, Zhi Tong, Xiaomei Lin, Xinzhu |
author_facet | Zhu, Yao Yang, Qing Wu, Fan Mao, Jian Liu, Ling Zhang, Rong Shen, Wei Tang, Lixia Chang, Yanmei Ye, Xiuzhen Qiu, Yinping Ma, Li Cheng, Rui Wu, Hui Chen, Dongmei Zheng, Zhi Tong, Xiaomei Lin, Xinzhu |
author_sort | Zhu, Yao |
collection | PubMed |
description | BACKGROUND: Infants with rule-out infections are responsible for the majority of empirical antibiotics treatment (EAT) in neonatal intensive care units (NICUs), particularly very preterm infants (VPIs). Antibiotic overuse has been linked to adverse outcomes. There is a paucity of data on the association between EAT and clinical outcomes (containing the nutritional outcomes) of VPIs without infection-related morbidities. METHODS: Clinical data of VPIs admitted in 28 hospitals in 20 provinces of China from September 2019 to December 2020 were collected. EAT of VPIs was calculated as the number of days with initial usage in the first week after birth, and then categorized into 3 groups (antibiotic exposure: none, 1-4 days, and > 4 days). Clinical characteristics, nutritional status , and the short-term clinical outcomes among 3 groups were compared and analyzed. RESULTS: In total, 1834 VPIs without infection-related morbidities in the first postnatal week were enrolled, including 152 cases (8.3%) without antibiotics, 374 cases (20.4%) with EAT ≤4 days and 1308 cases (71.3%) with EAT > 4 days. After adjusting for the confounding variables, longer duration of EAT was associated with decreased weight growth velocity and increased duration of reach of full enteral feeding in EAT > 4 days group (aβ: -4.83, 95% CI: − 6.12 ~ − 3.53; aβ: 2.77, 95% CI: 0.25 ~ 5.87, respectively) than those receiving no antibiotics. In addition, the risk of feeding intolerance (FI) in EAT > 4 days group was 4 times higher than that in non-antibiotic group (aOR: 4.14, 95%CI: 1.49 ~ 13.56) and 1.8 times higher than that in EAT ≤4 days group (aOR: 1.82, 95%CI: 1.08 ~ 3.17). EAT > 4 days was also a risk factor for greater than or equal to stage 2 necrotizing enterocolitis (NEC) than those who did not receive antibiotics (aOR: 7.68, 95%CI: 1.14 ~ 54.75) and those who received EAT ≤4 days antibiotics (aOR: 5.42, 95%CI: 1.94 ~ 14.80). CONCLUSIONS: The EAT rate among uninfected VPIs was high in Chinese NICUs. Prolonged antibiotic exposure was associated with decreased weight growth velocity, longer duration of reach of full enteral feeding, increased risk of feeding intolerance and NEC ≥ stage 2. Future stewardship interventions to reduce EAT use should be designed and implemented. |
format | Online Article Text |
id | pubmed-9878784 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-98787842023-01-27 The impact of early empirical antibiotics treatment on clinical outcome of very preterm infants: a nationwide multicentre study in China Zhu, Yao Yang, Qing Wu, Fan Mao, Jian Liu, Ling Zhang, Rong Shen, Wei Tang, Lixia Chang, Yanmei Ye, Xiuzhen Qiu, Yinping Ma, Li Cheng, Rui Wu, Hui Chen, Dongmei Zheng, Zhi Tong, Xiaomei Lin, Xinzhu Ital J Pediatr Research BACKGROUND: Infants with rule-out infections are responsible for the majority of empirical antibiotics treatment (EAT) in neonatal intensive care units (NICUs), particularly very preterm infants (VPIs). Antibiotic overuse has been linked to adverse outcomes. There is a paucity of data on the association between EAT and clinical outcomes (containing the nutritional outcomes) of VPIs without infection-related morbidities. METHODS: Clinical data of VPIs admitted in 28 hospitals in 20 provinces of China from September 2019 to December 2020 were collected. EAT of VPIs was calculated as the number of days with initial usage in the first week after birth, and then categorized into 3 groups (antibiotic exposure: none, 1-4 days, and > 4 days). Clinical characteristics, nutritional status , and the short-term clinical outcomes among 3 groups were compared and analyzed. RESULTS: In total, 1834 VPIs without infection-related morbidities in the first postnatal week were enrolled, including 152 cases (8.3%) without antibiotics, 374 cases (20.4%) with EAT ≤4 days and 1308 cases (71.3%) with EAT > 4 days. After adjusting for the confounding variables, longer duration of EAT was associated with decreased weight growth velocity and increased duration of reach of full enteral feeding in EAT > 4 days group (aβ: -4.83, 95% CI: − 6.12 ~ − 3.53; aβ: 2.77, 95% CI: 0.25 ~ 5.87, respectively) than those receiving no antibiotics. In addition, the risk of feeding intolerance (FI) in EAT > 4 days group was 4 times higher than that in non-antibiotic group (aOR: 4.14, 95%CI: 1.49 ~ 13.56) and 1.8 times higher than that in EAT ≤4 days group (aOR: 1.82, 95%CI: 1.08 ~ 3.17). EAT > 4 days was also a risk factor for greater than or equal to stage 2 necrotizing enterocolitis (NEC) than those who did not receive antibiotics (aOR: 7.68, 95%CI: 1.14 ~ 54.75) and those who received EAT ≤4 days antibiotics (aOR: 5.42, 95%CI: 1.94 ~ 14.80). CONCLUSIONS: The EAT rate among uninfected VPIs was high in Chinese NICUs. Prolonged antibiotic exposure was associated with decreased weight growth velocity, longer duration of reach of full enteral feeding, increased risk of feeding intolerance and NEC ≥ stage 2. Future stewardship interventions to reduce EAT use should be designed and implemented. BioMed Central 2023-01-26 /pmc/articles/PMC9878784/ /pubmed/36698176 http://dx.doi.org/10.1186/s13052-023-01414-x Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Zhu, Yao Yang, Qing Wu, Fan Mao, Jian Liu, Ling Zhang, Rong Shen, Wei Tang, Lixia Chang, Yanmei Ye, Xiuzhen Qiu, Yinping Ma, Li Cheng, Rui Wu, Hui Chen, Dongmei Zheng, Zhi Tong, Xiaomei Lin, Xinzhu The impact of early empirical antibiotics treatment on clinical outcome of very preterm infants: a nationwide multicentre study in China |
title | The impact of early empirical antibiotics treatment on clinical outcome of very preterm infants: a nationwide multicentre study in China |
title_full | The impact of early empirical antibiotics treatment on clinical outcome of very preterm infants: a nationwide multicentre study in China |
title_fullStr | The impact of early empirical antibiotics treatment on clinical outcome of very preterm infants: a nationwide multicentre study in China |
title_full_unstemmed | The impact of early empirical antibiotics treatment on clinical outcome of very preterm infants: a nationwide multicentre study in China |
title_short | The impact of early empirical antibiotics treatment on clinical outcome of very preterm infants: a nationwide multicentre study in China |
title_sort | impact of early empirical antibiotics treatment on clinical outcome of very preterm infants: a nationwide multicentre study in china |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9878784/ https://www.ncbi.nlm.nih.gov/pubmed/36698176 http://dx.doi.org/10.1186/s13052-023-01414-x |
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