Mesilhy Rowan, Safra Ibrahim, Alnaimi Shaikha, Ali Ala, Terkawi Rayan, Gaffari Mohammed, Alhendawi Talal, Vellamgot Anvar P, Gad Ashraf
Department of Internal Medicine, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar.
Neonatal Intensive Care Unit, Critical Care Department, Women's Wellness and Research Center, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar.
Antibiotics (Basel). 2025 Sep 12;14(9):925. doi: 10.3390/antibiotics14090925.
Early-onset neonatal meningitis (EONM) is a rare but serious condition where antibiotics are often given for extended periods, even without a positive cerebrospinal fluid (CSF) culture. The reasons for this prolonged treatment are unknown. This study, conducted at the Women's Wellness and Research Center, Doha, retrospectively analyzed the determinants of prolonged antibiotic therapy among neonates with sterile CSF cultures during the first week of life, born during 2015 to 2018. Of 315 neonates without confirmed meningitis, 96 (30.5%) received prolonged antibiotic therapy. These infants had significantly lower birth weights (2790 g vs. 3170 g) and gestational ages (36.7 weeks vs. 38.5 weeks). They were more likely to require respiratory support, appear ill, and have laboratory abnormalities, including neutropenia, positive blood cultures (36.5% vs. 0.9%), elevated C-reactive protein (CRP), and higher CSF protein. Multivariable analysis identified low Apgar scores (Adjusted Odds Ratio (aOR), 2.82), positive blood cultures (aOR, 118.48), traumatic lumbar puncture (LP) (aOR, 2.14), CRP levels ≥ 50 mg/L (aOR, 2.60), delayed LP (OR, 8.28), and elevated cerebrospinal fluid white cell counts (aOR, 5.47) as independent predictors of prolonged antibiotic use. Prolonged antibiotic use in neonates with sterile CSF cultures and suspected EONS is common and may be driven by certain clinical and laboratory indicators of illness severity and inflammation. Identifying these predictors can support risk-stratified treatment decisions, promoting safer antimicrobial stewardship.
早发型新生儿脑膜炎（EONM）是一种罕见但严重的疾病，即使脑脊液（CSF）培养结果为阴性，抗生素通常也需要长时间使用。这种延长治疗的原因尚不清楚。本研究在多哈妇女健康与研究中心进行，回顾性分析了2015年至2018年出生的、出生后第一周脑脊液培养无菌的新生儿长期使用抗生素治疗的决定因素。在315例未确诊脑膜炎的新生儿中，96例（30.5%）接受了延长抗生素治疗。这些婴儿的出生体重（2790克对3170克）和胎龄（36.7周对38.5周）显著更低。他们更有可能需要呼吸支持、看起来病情较重，并且有实验室异常，包括中性粒细胞减少、血培养阳性（36.5%对0.9%）、C反应蛋白（CRP）升高以及脑脊液蛋白水平更高。多变量分析确定低Apgar评分（调整优势比（aOR），2.82）、血培养阳性（aOR，118.48）、创伤性腰椎穿刺（LP）（aOR，2.14）、CRP水平≥50毫克/升（aOR，2.60）、延迟LP（OR，8.28）以及脑脊液白细胞计数升高（aOR，5.47）是延长抗生素使用的独立预测因素。脑脊液培养无菌且疑似EONS的新生儿长期使用抗生素很常见，可能由疾病严重程度和炎症的某些临床及实验室指标所驱动。识别这些预测因素有助于支持基于风险分层的治疗决策，促进更安全的抗菌药物管理。
