Effects Of Antibiotic Therapy With Different Antimicrobial Spectrums On Adverse Outcomes In Very Low Birth Weight Infants

Objective: To compare whether there is any difference between the effects of antibiotic therapy with various antimicrobial spectrums on risks of adverse outcomes in very low birth weight infants(VLBW)without culture-proven sepsis or necrotizing enterocolitis(NEC).Methods: A retrospective cohort study was conducted on very low birth weight neonates admitted to the neonatal intensive care unit(NICU)of Children's Hospital of Chongqing Medical University between January 1,2006,and April 30,2018.Multivariate logistic regression model was used to evaluate correlation of the duration of antibiotic therapy and risks of adverse outcomes in VLBW,and compare the differences between the effects of antibiotic therapy with various antimicrobial spectrums.Results: 657 VLBW were included in final study,of which 305 had adverse outcomes.Multivariate analysis showed that pneumorrhagia and duration of mechanical ventilation were independent risk factors of adverse consequences,while gestational age and birth weight were protective.Prolonged antibiotic therapy was associated with increased risks of adverse consequences.Thereinto,each additional day of broad-spectrum antibiotic therapy was responsible for higher risks of adverse outcomes(OR=1.049,95%CI: 1.018-1.080),while narrow-spectrum antibiotic use had nothing todo with consequences.Further restrictive cubic spline model was used to evaluate the association between the duration of broad-spectrum antibiotic therapy and the probability of adverse consequences,which showed the probability of bronchopulmonary dysplasia(BPD),retinopathy of prematurity(ROP),periventricular leukomalacia(PVL)and fungal infection increased in a non-linear fashion with prolonged duration of broad-spectrum antibiotic therapy.While with the extension of broad-spectrum antibiotic therapy,the probability of mortality and the composite outcome was slightly dropped and then increased and remained the lowest when infants received broad-spectrum antibiotic therapy for11-12 days.Conclusion: There were a few differences between the effects of antibiotic therapy with various antimicrobial spectrums on adverse consequences.Prolonged duration of broad-spectrum antibiotic therapy was responsible for higher risks of adverse outcomes.In clinical practice,we should stop using broad-spectrum antibiotics or take antibiotic de-escalation therapy timely if conditions permit to lower the risks of adverse outcomes.