ArticlePediatric research2025
Antibiotic exposure for culture-negative early-onset sepsis in late-preterm and term newborns: an international study.
Article in Pediatric research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed.
- Early-onset neonatal sepsis and neonatal antibiotic exposure in Hungary a nationwide population-based study.European journal of pediatrics · 2026Article
- The Goldilocks zone of optimal antimicrobial stewardship in preterm infants.Pediatric research · 2026Article
- Evolution of Antimicrobial Resistance in Neonatal Sepsis: A Narrative Review.Antibiotics (Basel, Switzerland) · 2026Review
- Blood cultures to define neonatal early-onset sepsis: why not enough for clinical care?Pediatric research · 2026Article
- Future perspectives on the use of molecular assays for pathogen identification in neonatal sepsis: a survey study among members of the European Society for Paediatric Infectious Diseases.BMJ paediatrics open · 2026Article
- Restricting C-Reactive Protein Use in Early-Onset Neonatal Sepsis Reduces Unnecessary Antibiotic Exposure.Antibiotics (Basel, Switzerland) · 2026Article
- Article
- Institutional Practices Drive Antibiotic Variability in Neonatal Intensive Care Units: Baseline Evidence to Inform National Stewardship Interventions in Oman.Antibiotics (Basel, Switzerland) · 2026Article
- Perioperative management of infected skin defect with poor wound healing in a neonate with Pentalogy of Cantrell associated with single ventricle and ectopia cordis: a case report and literature review.Frontiers in pediatrics · 2026Article
- Identifying Infants <32 Weeks' Gestation at Low Risk of Early-Onset Sepsis: A 10-Year Retrospective Study from Western Australia.Neonatology · 2026Article
- Antibiotic exposure for suspected early-onset sepsis in late-preterm and full-term newborns in Quebec: a 11-year single-center cohort study.Frontiers in pediatrics · 2026Article
- Antibiotic use in neonates with hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia: time to rethink universal empirical treatment.European journal of pediatrics · 2025Article
- Article
- Epidemiology and Outcomes of Late-Onset Neonatal Sepsis in Preterm Infants in a Tertiary Hospital.Children (Basel, Switzerland) · 2025Article
- Antibiotics for culture-negative neonatal early-onset sepsis: measuring the unmeasurable.Pediatric research · 2025Article
- Aligning prediction models with clinical information needs: infant sepsis case study.JAMIA open · 2025Article
- Microbial Infections and Antimicrobial Use in Neonates and Infants.Tropical medicine and infectious disease · 2025Article
- Four-factor nomogram for early-onset sepsis in preterm neonates: Development and internal validation of a stewardship tool.PloS one · 2025Article
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Authors and funding
26 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEarly-life antibiotic exposure is disproportionately high compared to the burden of culture-proven early-onset sepsis (CP-EOS). We assessed the contribution of culture-negative cases to the overall antibiotic exposure in the first postnatal week.
methodsWe conducted a retrospective analysis across eleven countries in Europe, North America, and Australia. All late-preterm and term infants born between 2014 and 2018 who received intravenous antibiotics during the first postnatal week were classified as culture-negative cases treated for ≥5 days (CN ≥ 5d), culture-negative cases treated for <5 days (CN < 5d), or CP-EOS cases.
resultsOut of 757,979 infants, 21,703 (2.9%) received intravenous antibiotics. The number of infants classified as CN ≥ 5d, CN < 5d, and CP-EOS was 7996 (37%), 13,330 (61%), and 375 (1.7%). The incidence of CN ≥ 5d, CN < 5d, and CP-EOS was 10.6 (95% CI 10.3-10.8), 17.6 (95% CI 17.3-17.9), and 0.49 (95% CI 0.44-0.54) cases per 1000 livebirths. The median (IQR) number of antibiotic days administered for CN ≥ 5d, CN < 5d, and CP-EOS was 77 (77-78), 53 (52-53), and 5 (5-5) per 1000 livebirths.
conclusionsCN ≥ 5d substantially contributed to the overall antibiotic exposure, and was 21-fold more frequent than CP-EOS. Antimicrobial stewardship programs should focus on shortening antibiotic treatment for culture-negative cases. IMPACT: In a study of 757,979 infants born in high-income countries, we report a presumed culture-negative early-onset sepsis incidence of 10.6/1000 livebirths with an associated antibiotic exposure of 77 antibiotic days per 1000 livebirths. This study sheds light on the major contribution of presumed culture-negative early-onset sepsis to early-life antibiotic exposure. Given the diagnostic uncertainty surrounding culture-negative early-onset sepsis, the low mortality rate, and the disproportionate antibiotic exposure associated with this condition, our study emphasizes the importance of targeting culture-negative early-onset sepsis in antimicrobial stewardship programs.
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