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Early antibiotic exposure in very-low birth weight infants and infection risk at 3–7 days after birth

Journal of Perinatology volume 43, pages 1158–1165 (2023)Cite this article

Subjects

Abstract

Objective

To determine rates of late-onset infection (LOI) during postnatal days 3–7 among preterm infants, based on antibiotic exposure during days 0–2.

Study design

Retrospective cohort study of infants born <1500 grams and ≤30 weeks gestation, 2005–2018. We analyzed the incidence and microbiology of LOI at days 3–7 based on antibiotic exposure during postnatal days 0–2.

Results

The cohort included 88,574 infants, of whom 85% were antibiotic-exposed. Fewer antibiotic-exposed compared to unexposed infants developed LOI (1.5% vs. 2.1%; adjusted hazard ratio, 0.28, 95% CI 0.24–0.33). Among antibiotic-exposed compared to unexposed infants, Gram-negative (38% vs. 28%, p = 0.002) and fungal (11% vs. 1%, p < 0.001) species were more commonly isolated, and gram-positive organisms (49% vs. 70%, p < 0.001) were less commonly isolated.

Conclusions

We observed low overall rates of LOI at days 3–7 after birth, but antibiotic exposure from birth was associated with lower rates, and with differing microbiology, compared to no exposure.

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Data availability

The dataset analyzed during the current study derives from the Pediatrix Medical Group database and is not publicly available.

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Funding

Funding

SAC reports receiving research funding from the National Heart, Lung and Blood Institute of the National Institutes of Health (T32HL007891). KMP reports receiving research funding from the National Institutes of Health, from two contracts with the Centers for Disease Control and Prevention, and from the Children’s Hospital of Philadelphia. ML reports receiving support from the National Heart, Lung and Blood Institute of the National Institutes of Health (K24HL143283). RGG has received support from industry for research services (https://dcri.org/about-us/conflict-of-interest/).

Author information

Authors and Affiliations

  1. Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Sarah A. Coggins, Sagori Mukhopadhyay & Karen M. Puopolo

  2. Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA

    Sarah A. Coggins, Sagori Mukhopadhyay & Karen M. Puopolo

  3. Clinical Futures, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Sarah A. Coggins, Sagori Mukhopadhyay & Karen M. Puopolo

  4. Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Zachary Willis & Matthew Laughon

  5. Clemson University, Clemson, SC, USA

    Daniel K. Benjamin

  6. Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA

    Rachel G. Greenberg

  7. Duke Clinical Research Institute, Durham, NC, USA

    Rachel G. Greenberg

  8. The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, FL, USA

    Reese H. Clark

Authors
  1. Sarah A. Coggins
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  2. Zachary Willis
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  4. Sagori Mukhopadhyay
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  8. Karen M. Puopolo
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Contributions

Concept and design: SAC, ZW, DKB, ML, SM, RGG and KMP. Acquisition, analysis, or interpretation of data: all authors. Drafting of the manuscript: SAC. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: ZW and DKB. Administrative, technical, or material support: DKB and RHC. Study supervision: DKB, ML, RGG and KMP.

Corresponding author

Correspondence to Sarah A. Coggins.

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Coggins, S.A., Willis, Z., Benjamin, D.K. et al. Early antibiotic exposure in very-low birth weight infants and infection risk at 3–7 days after birth. J Perinatol 43, 1158–1165 (2023). https://doi.org/10.1038/s41372-023-01737-x

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