Low exposure to antibiotics in newborns may not increase risk of early-onset sepsis: JAMA

In a nationwide study conducted in Sweden, researchers have discovered that administering antibiotics to newborns during their first week of life does not substantially heighten the risk of early-onset sepsis (EOS) or associated mortality. This finding comes as a significant reassurance to healthcare providers and parents, amid growing concerns regarding the overuse of antibiotics and the development of antibiotic resistance.

The study results were published in the journal JAMA Network Open.

Antibiotic management is a boon in saving the lives of newborns with EOS. However irrational use may develop resistance and adverse outcomes in the development. Antibiotic prescriptions have to be scrutinized to optimize treatment strategies. Hence researchers from Sweden conducted a nationwide observational study titled the Sweden Neonatal Antibiotic Use study and examined data from over 1 million newborns born between 2012 and 2020 across various neonatal units. The study evaluated the relationship between antibiotic usage and the incidence of EOS among late-preterm and full-term neonates.

By including All hospital live births from 34 weeks' gestation, the study was carried out among the neonatal intensive care during the first week of life to identify 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.

Findings:

• The study found that only a small percentage (1.88%) of newborns received antibiotics during their first week of life.
• Of these, about 3.4% were diagnosed with EOS. Antibiotic treatment duration for newborns without EOS had a median of 5 days, totaling 113 antibiotic days per 1000 live births.
• Despite no significant change in neonatal antibiotic exposure or antibiotic days per 1000 live births over the study period, EOS incidence decreased significantly from 0.74 in 2012 to 0.34 in 2020.
• EOS-associated mortality remained stable at 1.39%.
• Remarkably, the researchers observed no significant increase in the incidence of EOS or associated mortality over the study period, despite the relatively low antibiotic exposure.
• The incidence of EOS was 0.63 per 1000 live births.

Unnecessary antibiotic use not only contributes to the emergence of antibiotic-resistant bacteria but also poses potential risks to newborns, including adverse effects and disruptions to the developing microbiome. Moving forward, the findings of this study may guide healthcare providers in optimizing antibiotic treatment strategies for newborns, striking a delicate balance between effective infection management and antimicrobial stewardship.

Further reading: Gyllensvärd J, Studahl M, Gustavsson L, et al. Antibiotic Use in Late Preterm and Full-Term Newborns. JAMA Netw Open. 2024;7(3):e243362. doi:10.1001/jamanetworkopen.2024.3362.