Antibiotic exposure in neonates and early adverse outcomes: a systematic review and meta-analysis
Top Cited Papers
- 24 March 2017
- journal article
- review article
- Published by Oxford University Press (OUP) in Journal of Antimicrobial Chemotherapy
- Vol. 72 (7), 1858-1870
- https://doi.org/10.1093/jac/dkx088
Abstract
Objectives: To systematically review and meta-analyse the relationship between antibiotic exposure in neonates and the following early adverse outcomes: necrotizing enterocolitis (NEC), invasive fungal infections (IFIs) and/or death. Methods: Data sources were PubMed, Embase, Medline and the Cochrane Database (to December 2016), supplemented by manual searches of reference lists. Randomized controlled trials (RCTs) and observational studies were included if they provided data on different categories of antibiotic exposures (yes versus no, long versus short duration, and/or broad- versus narrow-spectrum regimens) and the risk of developing NEC, IFI and/or death in the neonatal period. Two reviewers extracted data and evaluated the risk of bias using the Cochrane Handbook, adapted to include observational studies. When appropriate, meta-analyses were conducted using the random-effect model. Results: We identified 9 RCTs and 38 observational studies. The quality of the majority of studies was poor to moderate. There was a significant association between prolonged antibiotic exposure and an increased risk of NEC in five observational studies (5003 participants) and/or risk of death in five observational studies (13aEuro534 participants). Eleven of 15 studies with data on broad- versus narrow-spectrum regimens reported an increased risk of IFI after broad-spectrum antibiotic exposure, in particular with third-generation cephalosporins and carbapenems. Meta-analysis was limited by few and old RCTs, insufficient sample sizes and diversity of antibiotic exposure and outcomes reported. Conclusions: Prolonged antibiotic exposure in uninfected preterm infants is associated with an increased risk of NEC and/or death, and broad-spectrum antibiotic exposure is associated with an increased risk of IFI.Keywords
This publication has 72 references indexed in Scilit:
- The control of invasiveCandidainfection in very low birth weight infants by reduction in the use of 3rd generation cephalosporinKorean Journal of Pediatrics, 2013
- Antibiotic Exposure and IBD Development Among Children: A Population-Based Cohort StudyPublished by American Academy of Pediatrics (AAP) ,2012
- Candida albicans and Bacterial Microbiota Interactions in the Cecum during Recolonization following Broad-Spectrum Antibiotic TherapyInfection and Immunity, 2012
- Prolonged Initial Empirical Antibiotic Treatment is Associated with Adverse Outcomes in Premature InfantsThe Journal of Pediatrics, 2011
- Antibiotic Exposure in the Newborn Intensive Care Unit and the Risk of Necrotizing EnterocolitisThe Journal of Pediatrics, 2011
- Neonatal Candidiasis: Epidemiology, Risk Factors, and Clinical JudgmentPediatrics, 2010
- Adaptations of Candida albicans for Growth in the Mammalian Intestinal TractEukaryotic Cell, 2010
- 16S rRNA gene-based analysis of fecal microbiota from preterm infants with and without necrotizing enterocolitisThe ISME Journal, 2009
- Prolonged Duration of Initial Empirical Antibiotic Treatment Is Associated With Increased Rates of Necrotizing Enterocolitis and Death for Extremely Low Birth Weight InfantsPediatrics, 2009
- Systematic reviews of adverse effects: framework for a structured approachBMC Medical Research Methodology, 2007