The impact of early empirical antibiotics treatment on clinical outcome of very preterm infants: a nationwide multicentre study in China
Abstract 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...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | Italian Journal of Pediatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13052-023-01414-x |
| _version_ | 1811175758810316800 |
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| author | Yao Zhu Qing Yang Fan Wu Jian Mao Ling Liu Rong Zhang Wei Shen Lixia Tang Yanmei Chang Xiuzhen Ye Yinping Qiu Li Ma Rui Cheng Hui Wu Dongmei Chen Zhi Zheng Xiaomei Tong Xinzhu Lin on behalf of the Chinese Multicenter EUGR Collaborative Group |
| author_facet | Yao Zhu Qing Yang Fan Wu Jian Mao Ling Liu Rong Zhang Wei Shen Lixia Tang Yanmei Chang Xiuzhen Ye Yinping Qiu Li Ma Rui Cheng Hui Wu Dongmei Chen Zhi Zheng Xiaomei Tong Xinzhu Lin on behalf of the Chinese Multicenter EUGR Collaborative Group |
| author_sort | Yao Zhu |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-04-10T19:42:09Z |
| format | Article |
| id | doaj.art-91e435f46f7c4c798564677c105032d5 |
| institution | Directory Open Access Journal |
| issn | 1824-7288 |
| language | English |
| last_indexed | 2024-04-10T19:42:09Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Italian Journal of Pediatrics |
| spelling | doaj.art-91e435f46f7c4c798564677c105032d52023-01-29T12:17:55ZengBMCItalian Journal of Pediatrics1824-72882023-01-0149111110.1186/s13052-023-01414-xThe impact of early empirical antibiotics treatment on clinical outcome of very preterm infants: a nationwide multicentre study in ChinaYao Zhu0Qing Yang1Fan Wu2Jian Mao3Ling Liu4Rong Zhang5Wei Shen6Lixia Tang7Yanmei Chang8Xiuzhen Ye9Yinping Qiu10Li Ma11Rui Cheng12Hui Wu13Dongmei Chen14Zhi Zheng15Xiaomei Tong16Xinzhu Lin17on behalf of the Chinese Multicenter EUGR Collaborative GroupDepartment of Neonatology, Women and Children’s Hospital, School of Medicine, Xiamen UniversityDepartment of Neonatology, Women and Children’s Hospital, School of Medicine, Xiamen UniversityDepartment of Neonatology, The Third Affiliated Hospital of Guangzhou Medical UniversityDepartment of Pediatrics, Shengjing Hospital of China Medical UniversityDepartment of Neonatology, Guiyang Maternity and Child Health Hospital/Guiyang Children’s HospitalDepartment of Neonatology, Children’s Hospital of Fudan UniversityDepartment of Neonatology, Women and Children’s Hospital, School of Medicine, Xiamen UniversityDepartment of Neonatology, Women and Children’s Hospital, School of Medicine, Xiamen UniversityDepartment of Pediatrics, Peking University Third HospitalDepartment of Neonatology, Maternal and Children’s Hospital of Guangdong ProvinceDepartment of Neonatology, General Hospital of Ningxia Medical UniversityDepartment of Neonatology, Children’s Hospital of Hebei ProvinceDepartment of Neonatology, Children’s Hospital of Nanjing Medical UniversityDepartment of Neonatology, The First Hospital of Jilin UniversityDepartment of Neonatology, Quanzhou Maternity and Children’s HospitalDepartment of Neonatology, Women and Children’s Hospital, School of Medicine, Xiamen UniversityDepartment of Pediatrics, Peking University Third HospitalDepartment of Neonatology, Women and Children’s Hospital, School of Medicine, Xiamen UniversityAbstract 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.https://doi.org/10.1186/s13052-023-01414-xEmpirical antibiotics treatmentVery preterm infantsWeight growth velocityNecrotizing enterocolitis |
| spellingShingle | Yao Zhu Qing Yang Fan Wu Jian Mao Ling Liu Rong Zhang Wei Shen Lixia Tang Yanmei Chang Xiuzhen Ye Yinping Qiu Li Ma Rui Cheng Hui Wu Dongmei Chen Zhi Zheng Xiaomei Tong Xinzhu Lin on behalf of the Chinese Multicenter EUGR Collaborative Group The impact of early empirical antibiotics treatment on clinical outcome of very preterm infants: a nationwide multicentre study in China Italian Journal of Pediatrics Empirical antibiotics treatment Very preterm infants Weight growth velocity Necrotizing enterocolitis |
| 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 | Empirical antibiotics treatment Very preterm infants Weight growth velocity Necrotizing enterocolitis |
| url | https://doi.org/10.1186/s13052-023-01414-x |
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