The association of early antibiotic exposure with subsequent development of late-onset sepsis in preterm infants: a systematic review and meta-analysis studies

被引：0

作者：

YF Shamseldin ^{[1
]}

Heba Khaled ^{[2
]}

Muhammed Abdiwahab ^{[3
]}

Maha K. Abu Radwan ^{[4
]}

Abdalfattah Sabra ^{[5
]}

Mona Mohammed ^{[6
]}

Sarah EL-Sayegh ^{[7
]}

Dina Abdel Rasoul Helal ^{[8
]}

Mahmoud E. Kamal ^{[9
]}

Ahmed Hassan ^{[10
]}

Ahmed Azzam ^{[11
]}

机构：

[1] Department of Clinical Pharmacy, College of Pharmaceutical Sciences and Drug Manufacturing, Misr University for Science and Technology, Giza

[2] Department of Biochemistry, Faculty of Pharmacy, Cairo University, Cairo

[3] Tanta University Hospitals, Tanta

[4] Princess Muna College of Nursing, Mutha University, Mutha

[5] Al-Zagazig University AL Zagazig, Zagazig

[6] Pediatric resident Doctor at National Nutrition Institute, Cairo

[7] Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo

[8] Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura

[9] Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Egyptian Russian University, Cairo

[10] Department of Clinical Pharmacy, Faculty of Pharmacy, University of Sadat City, Menoufia, Sadat City

[11] Department of Microbiology and Immunology, Faculty of Pharmacy, Helwan University, Cairo

来源：

International Journal of Emergency Medicine | / 18卷 / 1期

关键词：

Early antibiotic exposure; Late-onset sepsis; Meta-analysis; Preterm infants;

D O I：

10.1186/s12245-025-00869-5

中图分类号：

学科分类号：

摘要：

Background: Early antibiotic exposure in preterm infants may disrupt gut microbiome development, affecting health. However, its link to late-onset sepsis (LOS) remains unclear. This meta-analysis aims to clarify the association while addressing confounding bias. Methods: This systematic review and meta-analysis, conducted per PRISMA guidelines, utilized PubMed, Scopus, Google Scholar, and Web of Science for comprehensive literature retrieval. Studies comparing preterm infants with sterile blood cultures who received early antibiotics (short or prolonged) to those without, using LOS as the primary outcome, were included. Comparisons between short- and prolonged-course antibiotics were also considered. Only studies with adjusted analyses for confounders were considered. Adjusted odds ratios (aOR) were meta-analyzed, and the prediction interval (PI) was calculated using R software. Results: Ten studies met the eligibility criteria, comprising a total sample size of 55,089 preterm infants. Among these, nine studies included 33,549 preterm infants and compared prolonged antibiotic exposure to short exposure. Prolonged exposure was not significantly associated with LOS (pooled aOR = 1.2, 95% CI 0.99–1.46, P = 0.066, PI = 0.66 to 2.19, I² = 67%). Limiting the analysis to five studies with sample sizes over 1,000 reduced heterogeneity (I² = 30%) and provided a more precise confidence interval (pooled aOR = 1.03, 95% CI 0.91–1.15). Four studies, involving 41,938 preterm infants, examined preterm infants exposed to prolonged antibiotics versus those not exposed and found no significant association (aOR = 0.91, 95% CI 0.82–1.02, P = 0.1, PI = 0.72 to 1.16, I² = 0). All four studies had sample sizes exceeding 1,000. Additionally, these studies compared preterm infants with short antibiotic exposure to non-exposure, revealing a slightly lower risk of LOS (aOR = 0.87, 95% CI 0.77–0.98, P = 0.024, I² = 0) and a PI of 0.76 to 1.14. Conclusions: Our findings indicate that prolonged early antibiotic exposure in preterm infants with sterile cultures does not significantly increase the risk of LOS compared to no antibiotic exposure. Interestingly, a shorter duration of antibiotic exposure might be associated with a slightly lower risk of LOS. © The Author(s) 2025.

引用

共 24 条

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