Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants

C. Michael Cotten, Sarah Taylor, Barbara Stoll, Ronald N. Goldberg, Nellie I. Hansen, Pablo J. Sanchez, Namasivayam Ambalavanan, Daniel K. Benjamin

Research output: Contribution to journalArticle

429 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)58-66
Number of pages9
JournalPediatrics
Volume123
Issue number1
DOIs
StatePublished - Jan 2009

Fingerprint

Extremely Low Birth Weight Infant
Necrotizing Enterocolitis
Anti-Bacterial Agents
Therapeutics
Multivariate Analysis
Apgar Score

Keywords

  • Antibiotic use
  • Bloodstream infection
  • Death
  • Extremely low birth weight infants
  • Necrotizing enterocolitis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. / Michael Cotten, C.; Taylor, Sarah; Stoll, Barbara; Goldberg, Ronald N.; Hansen, Nellie I.; Sanchez, Pablo J.; Ambalavanan, Namasivayam; Benjamin, Daniel K.

In: Pediatrics, Vol. 123, No. 1, 01.2009, p. 58-66.

Research output: Contribution to journalArticle

Michael Cotten, C, Taylor, S, Stoll, B, Goldberg, RN, Hansen, NI, Sanchez, PJ, Ambalavanan, N & Benjamin, DK 2009, 'Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants', Pediatrics, vol. 123, no. 1, pp. 58-66. https://doi.org/10.1542/peds.2007-3423
Michael Cotten, C. ; Taylor, Sarah ; Stoll, Barbara ; Goldberg, Ronald N. ; Hansen, Nellie I. ; Sanchez, Pablo J. ; Ambalavanan, Namasivayam ; Benjamin, Daniel K. / Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. In: Pediatrics. 2009 ; Vol. 123, No. 1. pp. 58-66.
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AU - Michael Cotten, C.

AU - Taylor, Sarah

AU - Stoll, Barbara

AU - Goldberg, Ronald N.

AU - Hansen, Nellie I.

AU - Sanchez, Pablo J.

AU - Ambalavanan, Namasivayam

AU - Benjamin, Daniel K.

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N2 - 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.

AB - 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.

KW - Antibiotic use

KW - Bloodstream infection

KW - Death

KW - Extremely low birth weight infants

KW - Necrotizing enterocolitis

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