早期经验性抗生素延长暴露对早产儿住院结局的影响

Effect of prolonged early empirical antibiotic exposures on hospitalization outcomes of premature infants

目的回顾性分析胎龄<32周或出生体重<1500 g早产儿的临床资料,探讨早产儿早期经验性抗生素延长暴露对早产儿住院结局的影响,进一步指导早产儿抗生素的合理应用。方法收集青岛大学附属医院2018年1月1日到2020年12月31日收治的胎龄<32周或出生体重<1500 g的早产儿临床资料。按照生后早期经验性抗生素应用时间分为短期暴露组(≤5 d)和长期暴露组(>5 d),分析比较两组早产儿住院期间并发症。结果共291例,男166例,女125例。抗生素短期暴露组抗生素使用中位时间为3 d,长期暴露组抗生素使用中位时间为9 d。与短期暴露组相比,长期暴露组早产儿喂养不耐受(feeding intolerance,FI)发生率明显增加,达半量肠内喂养时间、达全肠内喂养时间及住院时间明显延长(P<0.05),长期暴露组早产儿支气管肺发育不良(bronchopulmonary dysplasia,BPD)、晚发败血症(late-onset sepsis,LOS)的发生率明显升高(P<0.05)。单因素logistic回归分析显示,抗生素延长暴露与住院期间FI、BPD、LOS、复合不良结局发生率增加均相关。多因素logistic回归分析显示经验性抗生素延长暴露是FI、BPD的独立危险因素,多元线性回归分析显示抗生素暴露时间越长,住院时间及达全肠内喂养时间越长。结论经验性抗生素延长暴露可增加早产儿BPD风险,影响肠道喂养,导致住院时间延长。

Objective To explore the effect of prolonged early empirical antibiotic exposures on the hospitalization outcome of preterm infants by retrospectively analyzing the clinical data of preterm infants born with gestational age<32 weeks or birth weight<1500 g,and to further guide the rational application of antibiotics in preterm infants.Methods Clinical data of preterm infants born with gestational age<32 weeks or birth weight<1500 g in the Affiliated Hospital of Qingdao University from January 1,2018 to December 31,2020 were collected.They were divided into short-term exposure group(≤5 days)and long-term exposure group(>5 days)according to the duration of empirical antibiotic application in the early postnatal period.The complications during hospitalization between the two groups were analyzed and compared.Results A total of 291 cases were retrospectively included,involving 166 males and 125 females.The median duration of antibiotic use in the short-term and long-term exposure groups was 3 days and 9 days,respectively.Compared with those of the short-term exposure group,cases in the long-term exposure group presented significantly higher incidence of feeding intolerance(FI),and longer duration of half-intestinal feeding,full intestinal feeding and the length of stay(P<0.05).The incidence of bronchopulmonary dysplasia(BPD)and late-onset sepsis(LOS)was significantly higher in the long-term exposure group than that of the short-term exposure group(P<0.05).Univariate Logistic regression analysis showed that prolonged antibiotic exposure was associated with increased incidences of FI,BPD,LOS,and composite outcomes during hospitalization.Multivariate Logistic regression analysis showed that prolonged exposure of empirical antibiotics was an independent risk factor for FI and BPD.Multiple linear regression analysis showed that the duration of antibiotic use was positively correlated with the length of stay and the length of whole intestinal feeding.Conclusion Prolonged early empirical antibiotic exposures can increase the risk of BPD in preterm infants,affect intestinal feeding,and lead to a longer length of stay.