Temporal Trends and Center Variation in Early Antibiotic Use Among Premature Infants

Abstract

Key Points Question Have empirical early antibiotic prescribing patterns for premature infants changed over time? Findings This multicenter cohort study of more than 40 000 premature infants found that most premature infants received early antibiotic administration and that rates of initiation of empirical early antibiotic therapy did not change from 2009 to 2015. Rates of prolonged antibiotic administration among very low-birth-weight infants decreased slightly, but did not change among extremely low-birth-weight infants. Meaning Despite concerns regarding the negative impact of early and prolonged empirical antibiotic use among premature newborns, neonatal clinicians across the United States continue to prescribe empirical antibiotics to the majority of very low-birth-weight infants in the first 3 days of age.

Microbiota Supplementation with Bifidobacterium and Lactobacillus Modifies the Preterm Infant Gut Microbiota and Metabolome: An Observational Study

“…Rates of antibiotic prescription in preterm infants are remarkably high, ranging from 79% to 87% in extremely low-birth-weight (<1,000 g) preterm infants. 44 , 45 Antibiotic treatment favors the establishment of antibiotic-resistant bacteria while indirectly eradicating highly susceptible microbiota members such as Bifidobacterium. 2 , 46 Indeed, it appears that long- (but not short-) term antibiotic usage is correlated with reduced Bifidobacterium abundance (linking with low antimicrobial resistance genomic and phenotypic profiles in the supplemented B. bifidum strain), while potentially multidrug-resistant pathobionts such as Klebsiella and Escherichia abundance were unaffected by antibiotic duration.…”

Challenges and opportunities for antibiotic stewardship among preterm infants

“…Antibiotics are the most commonly used drugs in the neonatal intensive care unit (NICU) 1. More than 75% of very low birthweight infants (birth weight <1500 g, VLBW) and over 80% of extremely low birthweight infants (birth weight <1000 g, ELBW) receive antibiotics for the risk of early-onset sepsis (EOS, infection occurring <72 hours of age) 2 3. Two-thirds of VLBW infants cared for in the NICHD Neonatal Research Network (NRN) centres are evaluated at least once for late-onset sepsis (LOS, infection occurring ≥72 hours of age) 4.…”

Persistent metagenomic signatures of early-life hospitalization and antibiotic treatment in the infant gut microbiota and resistome

“…Over 11% of live births worldwide occur preterm 25 , and preterm birth and its sequelae are prominent causes of childhood morbidity and mortality worldwide 26 . Because bacterial infections are frequent complications of preterm birth 27 , 79% of very low birthweight and 87% of extremely low birthweight infants in US NICUs receive antibiotics within three days of birth 29 . The gastrointestinal tracts of even healthy infants harbor a diverse antibiotic resistome 30 , which is shaped by factors including antibiotics, diet, and environment [31][32][33] .…”