Effect of an optimized antibiotic management on the short-term clinical outcome of preterm infants born with gestational age of<32 weeks

doi:10.3969/j.issn.1004-583X.2023.08.005

Abstract

Abstract:

Objective To explore the effect of an optimized antibiotic management on the short-term clinical outcome of preterm infants born with gestational age of<32 weeks by retrospectively analyzing their clinical data. Methods Clinical data were retrospectively collected from preterm infants born with gestational age of <32 weeks who were admitted to the Neonatal Intensive Care Unit of the Affiliated Hospital of Qingdao University from January 1, 2017 to June 30, 2018 and from January 1, 2019 to December 31, 2020. The optimized antibiotic strategy was implemented since January 1, 2019. Included preterm infants were divided into two groups, including pre-optimization group (January 1, 2017 to June 30, 2018, n=158) and optimization group (January 1, 2019 to December 31, 2020, n=156). The clinical data of preterm infants were compared between groups.Results Compared with the pre-optimization group, the duration of antibiotic use in the early postnatal period (6 d vs 10 d), the total duration of antibiotic use during hospitalization (11 d vs 16 d), and the duration of parenteral nutrition (18 d vs 29.5 d) in the optimization group were significantly shortened (P<0.01). The incidence rate of retinopathy of prematurity (ROP) in the optimization group was significantly lower than that in the pre-optimization group (7.69% vs 15.82%, P<0.05). The multivariate logistic regression analysis revealed that optimized antibiotic management was not significantly correlated with short-term adverse outcomes (P>0.05). Prolonged antibiotic use, positive blood culture and mechanical ventilation were risk factors for short-term adverse clinical outcome.Conclusion Shortening unnecessary antibiotic exposure in preterm infants can reduce the duration of parenteral nutrition and the incidence of ROP without increasing short-term adverse clinical outcomes. Prolonged antibiotic use increases the risk of adverse clinical outcome.

Key words: infant, premature, optimized antibiotic management, adverse outcome

CLC Number:

R722

Xue Ruirui, Li Xianghong, Li Liangliang, Yin Xiangyun, Xi Hongmin, Yang Ping, Ma Lili. Effect of an optimized antibiotic management on the short-term clinical outcome of preterm infants born with gestational age of<32 weeks[J]. Clinical Focus, 2023, 38(8): 706-713.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.08.005

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I8/706

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References 37

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项目	优化前组(n=158)	优化组(n=156)	χ²/t值	P值
患儿性别[例(%)]
女性男性	68(43.04) 90(56.96)	68(43.59) 88(56.41)	0.010	0.921
胎龄(w)	30.23±1.23	29.79±1.56	2.81	0.005
出生体重(g)	1382.71±279.28	1311.96±331.63	2.044	0.042
1 min评分[例(%)]
>7 ≤7	112(70.89) 46(29.11)	102(65.38) 54(34.62)	1.095	0.295
5 min评分[例(%)]
>7 ≤7	140(88.61) 18(11.39)	134(85.90) 22(14.10)	0.519	0.471
SGA[例(%)]
否是	123(77.85) 35(22.15)	145(92.95) 11(7.05)	14.316	<0.01
分娩方式[例(%)]
顺产剖宫产	48(30.38) 110(69.62)	36(23.08) 120(76.92)	2.136	0.144
单多胎分组[例(%)]
单胎	102(64.56)	120(76.92)
双胎	44(27.85)	33(21.15)	8.418	0.015
三胎	12(7.59)	3(1.92)
试管婴儿[例(%)]
否是	128(81.01) 30(18.99)	129(82.69) 27(17.31)	0.149	0.699
窒息[例(%)]
否是	108(68.35) 50(31.65)	105(67.31) 51(32.69)	0.039	0.843
窒息抢救情况[例(%)]
否是	119(75.32) 39(24.68)	115(73.72) 14(8.97)	0.106	0.745
白细胞计数异常(生后24 h内)[例(%)]
否是	141(89.24) 17(10.76)	125(80.13) 31(19.87)	5.033	0.025
C反应蛋白升高[例(%)]
否是	151(95.57) 7(4.43)	153(98.08) 3(1.92)	0.891	0.345
血小板减少[例(%)]
否是	153(96.84) 5(3.16)	154(98.72) 2(1.28)	0.559	0.455
血培养阳性[例(%)]
否是	155(98.10) 3(1.90)	141(90.38) 15(9.62)	8.650	0.003
EOS(临床诊断)[例(%)]
否是	141(89.24) 17(10.76)	148(94.87) 8(5.13)	3.397	0.065
PICC应用[例(%)]
否是	96(60.76) 62(39.24)	61(39.10) 95(60.90)	14.727	<0.001
PS应用[例(%)]
否是	97(61.39) 61(38.61)	102(65.38) 54(34.62)	0.539	0.463
机械通气[例(%)]
否是	121(76.58) 37(23.42)	134(85.90) 22(14.10)	4.464	0.035
孕母年龄(岁)	30.72±4.67	32.65±4.72	3.656	<0.01
产前发热[例(%)]
否	150(94.94)	147(94.23)
是	3(1.90)	8(5.13)	-	0.102
不详	5(3.16)	1(0.64)
产前抗生素[例(%)]
否	119(75.32)	97(62.18)
是	33(20.89)	58(37.18)	-	0.001
不详	6(3.80)	1(0.64)
产前激素[例(%)]
否	36(22.78)	41(26.28)
是	116(73.42)	115(73.72)	-	0.042
不详	6(3.80)	0(0.00)
胎膜早破(≥18 h)[例(%)]
否是	140(88.61) 18(11.39)	127(81.41) 29(18.59)	3.195	0.074
宫内窘迫[例(%)]
否是	140(88.61) 18(11.39)	129(82.69) 27(17.31)	2.237	0.149

项目	优化前组(n=158)	优化组(n=156)	χ²/t值	P值
患儿性别[例(%)]
女性男性	68(43.04) 90(56.96)	68(43.59) 88(56.41)	0.010	0.921
胎龄(w)	30.23±1.23	29.79±1.56	2.81	0.005
出生体重(g)	1382.71±279.28	1311.96±331.63	2.044	0.042
1 min评分[例(%)]
>7 ≤7	112(70.89) 46(29.11)	102(65.38) 54(34.62)	1.095	0.295
5 min评分[例(%)]
>7 ≤7	140(88.61) 18(11.39)	134(85.90) 22(14.10)	0.519	0.471
SGA[例(%)]
否是	123(77.85) 35(22.15)	145(92.95) 11(7.05)	14.316	<0.01
分娩方式[例(%)]
顺产剖宫产	48(30.38) 110(69.62)	36(23.08) 120(76.92)	2.136	0.144
单多胎分组[例(%)]
单胎	102(64.56)	120(76.92)
双胎	44(27.85)	33(21.15)	8.418	0.015
三胎	12(7.59)	3(1.92)
试管婴儿[例(%)]
否是	128(81.01) 30(18.99)	129(82.69) 27(17.31)	0.149	0.699
窒息[例(%)]
否是	108(68.35) 50(31.65)	105(67.31) 51(32.69)	0.039	0.843
窒息抢救情况[例(%)]
否是	119(75.32) 39(24.68)	115(73.72) 14(8.97)	0.106	0.745
白细胞计数异常(生后24 h内)[例(%)]
否是	141(89.24) 17(10.76)	125(80.13) 31(19.87)	5.033	0.025
C反应蛋白升高[例(%)]
否是	151(95.57) 7(4.43)	153(98.08) 3(1.92)	0.891	0.345
血小板减少[例(%)]
否是	153(96.84) 5(3.16)	154(98.72) 2(1.28)	0.559	0.455
血培养阳性[例(%)]
否是	155(98.10) 3(1.90)	141(90.38) 15(9.62)	8.650	0.003
EOS(临床诊断)[例(%)]
否是	141(89.24) 17(10.76)	148(94.87) 8(5.13)	3.397	0.065
PICC应用[例(%)]
否是	96(60.76) 62(39.24)	61(39.10) 95(60.90)	14.727	<0.001
PS应用[例(%)]
否是	97(61.39) 61(38.61)	102(65.38) 54(34.62)	0.539	0.463
机械通气[例(%)]
否是	121(76.58) 37(23.42)	134(85.90) 22(14.10)	4.464	0.035
孕母年龄(岁)	30.72±4.67	32.65±4.72	3.656	<0.01
产前发热[例(%)]
否	150(94.94)	147(94.23)
是	3(1.90)	8(5.13)	-	0.102
不详	5(3.16)	1(0.64)
产前抗生素[例(%)]
否	119(75.32)	97(62.18)
是	33(20.89)	58(37.18)	-	0.001
不详	6(3.80)	1(0.64)
产前激素[例(%)]
否	36(22.78)	41(26.28)
是	116(73.42)	115(73.72)	-	0.042
不详	6(3.80)	0(0.00)
胎膜早破(≥18 h)[例(%)]
否是	140(88.61) 18(11.39)	127(81.41) 29(18.59)	3.195	0.074
宫内窘迫[例(%)]
否是	140(88.61) 18(11.39)	129(82.69) 27(17.31)	2.237	0.149

组别	例数	早期抗生素使用时间	抗生素使用总时间
优化前组	158	10.00(7.00~14.00)	16.00(8.00~28.00)
优化组	156	6.00(4.00~9.00)	11.00(6.00~22.00)
Z值		7.128	3.503
P值		<0.01	<0.01

组别	例数	早期抗生素使用时间	抗生素使用总时间
优化前组	158	10.00(7.00~14.00)	16.00(8.00~28.00)
优化组	156	6.00(4.00~9.00)	11.00(6.00~22.00)
Z值		7.128	3.503
P值		<0.01	<0.01

组别	例数	≤3 d	4~7 d	>7 d
优化前组	158	12(7.59)	12(7.59)	134(84.81)
优化组	156	22(14.10)	34(21.79)	100(64.1)
χ²值		18.391
P值		<0.01