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Prolonged Antibiotic Use in Preterm Infants with Negative Blood Culture

Valeria Sanchez

University of Texas Medical Branch

Purpose of Study Neonatal sepsis in premature infants can present with non-specific clinical presentations. This leads to prolonged (>48 hours) antibiotic use in preterm infants. The purpose of our study was to evaluate the role of prolonged antibiotic use in preterm infants with blood culture negative suspected early onset sepsis in late onset sepsis and hospital stay. Methods Used This is an observational retrospective study from January 2016 to December 2017 (24 months) of very low birth weight infants (<1500 grams) who were treated with antibiotics in first week of life. We included infants <30 weeks gestation and <1500 grams birth weight who received antibiotics for early onset sepsis and survived at least 7 days. All infants with known congenital or chromosomal anomalies were excluded from the study. Detailed prenatal and neonatal data was collected from the electronic medical records at University of Texas Medical Branch , Galveston. All subjects were divided into two groups. Prolonged antibiotics group who received antibiotics for first >72 hours for blood culture negative suspected sepsis. Control group included infants who received antibiotics <72 hours for blood culture negative suspected sepsis. We used chi square test and T-test with p value <0.05 was considered statistically significant. Results 146 eligible subjects were included in the study. Of these subjects, 109 of them met our inclusion criteria for the study. There were 52 female and 57 male infants with mean gestational age 26.5 +1.9 weeks and birth weight 865 +207 grams. 59 subjects received prolonged antibiotics and 50 received antibiotics <72 hours. There was significantly prolonged length of hospital stay in prolonged antibiotic group (109.15 versus 63.24 + 23.44 days p<0.05), as well as longer duration of Total Parenteral Nutrition (43.14 versus 17.84 +13.18 days p<0.05). There was no significant difference in late onset sepsis, necrotizing enterocolitis, or retinopathy of prematurity. Conclusions Prolonged antibiotic use in preterm infants with blood culture negative suspected sepsis in preterm infants extends the length of hospital stay and use of TPN. Various factors play a role in the decision of treatment of blood culture negative suspected sepsis, such as low birth weight, low gestation age, and chorioamnionitis. We should be cautious in using prolonged antibiotics in preterm infants with negative blood culture.

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