Less is more: Antibiotics at the beginning of life

Stocker, Martin; Klingenberg, Claus; Navér, Lars; Nordberg, Viveka; Berardi, Alberto; Helou, Salhab el; Fusch, Gerhard; Bliss, Joseph M.; Lehnick, Dirk; Dimopoulou, Varvara; Guerina, Nicholas G.; Seliga‐Siwecka, Joanna; Maton, Pierre; Lagae, Donatienne; Mari, Judit; Janota, J; Agyeman, Philipp; Pfister, Riccardo; Latorre, Giuseppe; Maffei, G; Laforgia, Nichola; Mózes, Enikő; Størdal, Ketil; Strunk, Tobias; Giannoni, Éric

doi:10.1038/s41467-023-38156-7

Cited by 37 publications

(25 citation statements)

References 94 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Neonatal sepsis is a serious condition that could rapidly become life-threatening; hence, clinical suspicion often leads to antibiotic therapy in newborns . Fear of missing sepsis in addition to suboptimal diagnostic biomarkers contribute to antibiotics being the most prescribed drug in neonatal units . Antibiotic exposure in early life influences the developing microbiome and may be associated with an increased risk of asthma, allergy, overweight, diabetes, and inflammatory bowel disease later in life .…”

Section: Introductionmentioning

confidence: 99%

Antibiotic Use in Late Preterm and Full-Term Newborns

Gyllensvärd,

Studahl,

Gustavsson

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceAntibiotic treatment saves lives in newborns with early-onset sepsis (EOS), but unwarranted antibiotic use is associated with resistant bacteria and adverse outcomes later in life. Surveillance is needed to optimize treatment strategies.ObjectiveTo describe antibiotic use in association with the incidence and mortality from EOS among late-preterm and full-term newborns.Design, Setting, and ParticipantsThe Sweden Neonatal Antibiotic Use study was a nationwide observational study that included all late-preterm and full-term neonates born from January 1, 2012, to December 31, 2020, in neonatal units of all levels. All hospital live births from 34 weeks’ gestation during the study period were included in the study. Data were collected from the Swedish Neonatal Quality Register and the Swedish Medical Birth Register. Data were analyzed from August 2022 to May 2023.ExposureAdmission for neonatal intensive care during the first week of life.Main Outcomes and MeasuresThe main outcomes were the usage of intravenous antibiotics during the first week of life, the duration of antibiotic therapy, the rate of culture-proven EOS, and mortality associated with EOS.ResultsA total of 1 025 515 newborns were included in the study; 19 286 neonates (1.88%; 7686 girls [39.9%]; median [IQR] gestational age, 40 [38-41] weeks; median [IQR] birth weight, 3610 [3140-4030] g) received antibiotics during the first week of life, of whom 647 (3.4%) had EOS. The median (IQR) duration of antibiotic treatment in newborns without EOS was 5 (3-7) days, and there were 113 antibiotic-days per 1000 live births. During the study period there was no significant change in the exposure to neonatal antibiotics or antibiotic-days per 1000 live births. The incidence of EOS was 0.63 per 1000 live births, with a significant decrease from 0.74 in 2012 to 0.34 in 2020. Mortality associated with EOS was 1.39% (9 of 647 newborns) and did not change significantly over time. For each newborn with EOS, antibiotic treatment was initiated in 29 newborns and 173 antibiotic-days were dispensed.Conclusions and RelevanceThis large nationwide study found that a relatively low exposure to antibiotics is not associated with an increased risk of EOS or associated mortality. Still, future efforts to reduce unwarranted neonatal antibiotic use are needed.

show abstract

Section: Introductionmentioning

confidence: 99%

Antibiotic Use in Late Preterm and Full-Term Newborns

Gyllensvärd,

Studahl,

Gustavsson

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

show abstract

“…Simultaneously, an estimated 214,000 neonatal deaths from sepsis each year are caused by antimicrobial resistance (AMR) [ 17 ], and AMR in neonatal sepsis is increasing rapidly [ 18 ]. It has been estimated for late preterm and full-term neonates that around 50–100 infants are given antibiotics for every true EOS case in high income countries [ 19 , 20 ]. This becomes further problematic as an association between antibiotic use in early life, dysbiosis of the neonatal intestinal microbiota and an increased risk of adverse short term- (e.g.…”

Section: Introductionmentioning

confidence: 99%

A decade of neonatal sepsis in Stockholm, Sweden: Gram-positive pathogens were four times as common as Gram-negatives

Oldendorff,

Nordberg,

Giske

et al. 2024

Eur J Clin Microbiol Infect Dis

Self Cite

View full text Add to dashboard Cite

Purpose To assess Gram-positive bacterial (GPB) bloodstream infection (BSI) in neonates, covering incidence, morbidity, mortality, antimicrobial resistance patterns and biomarkers in Region Stockholm, Sweden between 2006 and 2016. Methods A population-based retrospective epidemiological study including infants with GPB-BSI, admitted to the neonatal units at Karolinska University Hospital (KUH). Data were collected from patient records, the Swedish Neonatal Quality Register, the microbiological laboratory at KUH and the Swedish Public Health Agency. Results We identified 357 infants with GPB-BSI, representing an incidence of 1.47/1000 live births (LB). Group B streptococcus (GBS) was the most common pathogen causing BSI in full-term infants and early-onset sepsis (EOS) (0.20/1000 LB), while coagulase-negative staphylococci (CoNS) were predominant in infants born very preterm and in late-onset sepsis (LOS) (0.79/1000 LB). There were no fatal GBS BSI cases, but 10.2% developed meningitis. The GPB case fatality rate was 9.5% and the sepsis fatality rate 2.8%. In GPB-BSI, 1/10 did not have an elevated C-reactive protein level. Staphylococcus aureus (S. aureus) BSI increased during the study period, but no methicillin or vancomycin resistant strains were found. The antimicrobial resistance (AMR) rate was highest in CoNS isolates. Conclusion GPB-BSI was four times more common than Gram-negative BSI in neonates but resulted in lower mortality rate. GBS was the most common pathogen in full-term infants and in EOS. CoNS was the most common pathogen in LOS and infants born very preterm, and the AMR rate was high in these isolates. The increasing trend of S. aureus BSI indicates a need of further investigation.

show abstract

“…The use of antibiotics in neonatal intensive care units (NICUs) is under scrutiny not only because of rising antibiotic resistance in the neonatal population 1 but also for the short- and long-term negative health effects of early antibiotic use, 2 such as necrotizing enterocolitis, 3 bronchopulmonary dysplasia, 4 invasive candidiasis, 5 nosocomial infection and mortality, 6 and delayed initiation of breastfeeding of term newborns, 7 as well as asthma and obesity later in life. 8–10 …”

Section: Introductionmentioning

confidence: 99%

“… 13 Culture-negative sepsis is a poorly defined and overdiagnosed condition, with numerous noninfectious conditions that mimic sepsis being far more common. 2 …”

Section: Introductionmentioning

confidence: 99%

Antibiotic Use in a Neonatal Intensive Care Unit Practicing Integrative Medicine—A Retrospective Analysis

Vagedes,

Huber,

Islam

et al. 2024

Journal of Integrative and Complementary Medicine

View full text Add to dashboard Cite

Background: Antibiotic use in neonatal intensive care units (NICUs) remains high. Low antibiotic prescribing has been documented among physicians trained in complementary medicine. This study sought to identify if an NICU integrating complementary medicine has low antibiotic prescribing. Methods: We conducted a retrospective analysis at the level-2 NICU of the Filderklinik, an integrative medicine hospital in Southern Germany, to compare antibiotic use locally and internationally; to compare neonates with suspected infection, managed with and without antibiotics; and to describe use and safety of complementary medicinal products. Results: Among 7778 live births, 1086 neonates were hospitalized between 2014 and 2017. Two hundred forty-six were diagnosed with suspected or confirmed infection, their median gestational age was 40.3 weeks (range 29–42), 3.25% had a birthweight <2500 g, 176 were treated with antibiotics for a median duration of 4 days, 6 had culture-proven infection (0.77 per 1000 live births), and 2.26% of live births were started on antibiotics. A total of 866 antibiotic treatment days corresponded to 111 antibiotic days per 1000 live births and 8.8 antibiotic days per 100 hospital days. Neonates managed with antibiotics more often had fever and abnormal laboratory parameters than those managed without. Complementary medicinal products comprising 71 different natural substances were used, no side effect or adverse event were described. A subanalysis using the inclusion criteria of a recent analysis of 13 networks in Europe, North America, and Australia confirmed this cohort to be among the lowest prescribing networks. Conclusions: Antibiotic use was low in this NICU in both local and international comparison, while the disease burden was in the mid-range, confirming an association between integrative medicine practice and low antibiotic prescribing in newborns. Complementary medicinal products were widely used and well tolerated. Clinical Trial Registration number: NCT04893343.

show abstract

Less is more: Antibiotics at the beginning of life

Cited by 37 publications

References 94 publications

Antibiotic Use in Late Preterm and Full-Term Newborns

Antibiotic Use in Late Preterm and Full-Term Newborns

A decade of neonatal sepsis in Stockholm, Sweden: Gram-positive pathogens were four times as common as Gram-negatives

Antibiotic Use in a Neonatal Intensive Care Unit Practicing Integrative Medicine—A Retrospective Analysis

Contact Info

Product

Resources

About