Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden.
Department of Pediatrics, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
JAMA Netw Open. 2024 Mar 4;7(3):e243362. doi: 10.1001/jamanetworkopen.2024.3362.
Antibiotic treatment saves lives in newborns with early-onset sepsis (EOS), but unwarranted antibiotic use is associated with resistant bacteria and adverse outcomes later in life. Surveillance is needed to optimize treatment strategies.
To describe antibiotic use in association with the incidence and mortality from EOS among late-preterm and full-term newborns.
DESIGN, SETTING, AND PARTICIPANTS: The Sweden Neonatal Antibiotic Use study was a nationwide observational study that included all late-preterm and full-term neonates born from January 1, 2012, to December 31, 2020, in neonatal units of all levels. All hospital live births from 34 weeks' gestation during the study period were included in the study. Data were collected from the Swedish Neonatal Quality Register and the Swedish Medical Birth Register. Data were analyzed from August 2022 to May 2023.
Admission for neonatal intensive care during the first week of life.
The main outcomes were the usage of intravenous antibiotics during the first week of life, the duration of antibiotic therapy, the rate of culture-proven EOS, and mortality associated with EOS.
A total of 1 025 515 newborns were included in the study; 19 286 neonates (1.88%; 7686 girls [39.9%]; median [IQR] gestational age, 40 [38-41] weeks; median [IQR] birth weight, 3610 [3140-4030] g) received antibiotics during the first week of life, of whom 647 (3.4%) had EOS. The median (IQR) duration of antibiotic treatment in newborns without EOS was 5 (3-7) days, and there were 113 antibiotic-days per 1000 live births. During the study period there was no significant change in the exposure to neonatal antibiotics or antibiotic-days per 1000 live births. The incidence of EOS was 0.63 per 1000 live births, with a significant decrease from 0.74 in 2012 to 0.34 in 2020. Mortality associated with EOS was 1.39% (9 of 647 newborns) and did not change significantly over time. For each newborn with EOS, antibiotic treatment was initiated in 29 newborns and 173 antibiotic-days were dispensed.
This large nationwide study found that a relatively low exposure to antibiotics is not associated with an increased risk of EOS or associated mortality. Still, future efforts to reduce unwarranted neonatal antibiotic use are needed.
抗生素治疗可挽救早发性败血症（EOS）新生儿的生命，但不必要的抗生素使用与耐药菌和生命后期的不良后果有关。需要进行监测以优化治疗策略。
描述晚期早产儿和足月新生儿中 EOS 的抗生素使用与发病率和死亡率之间的关系。
设计、地点和参与者：瑞典新生儿抗生素使用研究是一项全国性的观察性研究，纳入了 2012 年 1 月 1 日至 2020 年 12 月 31 日期间所有各级新生儿单位中出生的所有晚期早产儿和足月新生儿。在此期间，所有妊娠 34 周以上的医院活产儿均纳入研究。数据来自瑞典新生儿质量登记处和瑞典医疗出生登记处。数据于 2022 年 8 月至 2023 年 5 月进行分析。
出生后第一周入住新生儿重症监护病房。
主要结局为出生后第一周静脉内使用抗生素、抗生素治疗持续时间、培养证实的 EOS 发生率以及 EOS 相关死亡率。
共纳入 1025515 名新生儿；19286 名新生儿（1.88%；7686 名女孩[39.9%]；中位[IQR]胎龄 40 [38-41] 周；中位[IQR]出生体重 3610 [3140-4030] g）在出生后第一周接受了抗生素治疗，其中 647 名（3.4%）患有 EOS。无 EOS 的新生儿抗生素治疗中位（IQR）持续时间为 5（3-7）天，每 1000 例活产儿有 113 个抗生素日。在研究期间，新生儿接受抗生素治疗的暴露率或每 1000 例活产儿的抗生素日数没有显著变化。EOS 的发病率为每 1000 例活产儿 0.63 例，从 2012 年的 0.74 例显著下降至 2020 年的 0.34 例。EOS 相关死亡率为 1.39%（647 例新生儿中的 9 例），且随时间无显著变化。对于每例 EOS 新生儿，有 29 例新生儿开始使用抗生素治疗，有 173 个抗生素日被开出。
这项大型全国性研究发现，相对较低的抗生素暴露与 EOS 或相关死亡率的增加无关。不过，仍需要进一步努力减少不必要的新生儿抗生素使用。
