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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2024年9月17日

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  • Varvara Dimopoulou,
  • Claus Klingenberg,
  • Lars Navér,
  • Viveka Nordberg,
  • Alberto Berardi,
  • Salhab el Helou,
  • Gerhard Fusch,
  • Joseph M. Bliss,
  • Dirk Lehnick,
  • Nicholas Guerina,
  • Joanna Seliga-Siwecka,
  • Pierre Maton,
  • Donatienne Lagae,
  • Judit Mari,
  • Jan Janota,
  • Philipp K. A. Agyeman,
  • Riccardo Pfister,
  • Giuseppe Latorre,
  • Gianfranco Maffei,
  • Nicola Laforgia,
  • Enikő Mózes,
  • Ketil Størdal,
  • Tobias Strunk,
  • Martin Stocker,
  • Eric Giannoni,
  • Capretti Maria Grazia,
  • Ceccoli Martina,
  • De Angelis Morena,
  • Drimaco Pietro,
  • Eap Khalyane,
  • el Helou Zoe,
  • Esmaeilizand Rana,
  • Foglianese Alessandra,
  • Geraci Carmelo,
  • Grochowski Bartłomiej,
  • Håkansson Stellan,
  • Kaur Sharandeep,
  • Kollegger Anne-Louise,
  • Oldendorff Frida,
  • Rizzo Vittoria,
  • Arild E. Rønnestad,
  • Shrestha Damber,
  • Stensvold Hans Jørgen,
  • Trefny Martin,
  • Zilinska Kristyna,
  • Zwijacz Aleksandra

摘要

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.