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Antibiotics overused among neonates at lower risk for early-onset sepsis

BALTIMORE — Prolonged antibiotic therapy continued to be administered to extremely preterm infants, including those with significantly lower risk for early-onset sepsis, according to recent research presented at the Pediatric Academic Societies Meeting.

“Most premature infants have some degree of respiratory or systemic instability that can make it difficult for clinicians to discontinue antibiotics in the face of sterile cultures,” Karen M. Puopolo, MD, PhD, of the section on newborn pediatrics at the University of Pennsylvania Perelman School of Medicine, told Infectious Diseases in Children. “Yet prolonged early antibiotic exposure is associated with increased risk of morbidity and mortality among very preterm infants. In this study we sought to identify a subset of premature infants with a lower risk of early-onset sepsis.”

The researchers studied 15,318 preterm infants born at 22 to 28 weeks’ gestation at Neonatal Research Network centers from 2006 to 2014. Participants weighed between 401 g and 1,500 g at birth and had no major birth defects. The researchers defined early-onset sepsis by positive blood or cerebrospinal fluid culture within 72 hours of birth.

Puopolo and colleagues determined that 33% of study participants met the criteria for low risk for early-onset sepsis, which was defined as infants born by cesarean section, with membrane rupture at or near delivery and in the absence of maternal chorioamnionitis, Puopolo said. However, prolonged antibiotic therapy still was administered to 33% of the low-risk infants compared with 47% in the remaining infants.

“Our findings may help neonatal clinicians recognize the differential risk of early-onset sepsis among premature infants, and therefore may help guide decisions to limit prolonged early antibiotic use in about 30% of these infants,” Puopolo said. “Such an outcome will positively impact the overall health of these infants.” – by David Costill 

Reference:

Mukhopadhyay S, et al. Abstract 2720A.3. Presented at: Pediatric Academic Societies Meeting; April 30-May 3, 2016; Baltimore.

Disclosure: The researchers report no relevant financial disclosures.