Evidence map›Paper›PMID 40251478›Full record

ReviewInternational journal of emergency medicine2025

The association of early antibiotic exposure with subsequent development of late-onset sepsis in preterm infants: a systematic review and meta-analysis studies.

Y F Shamseldin, Heba Khaled, Muhammed Abdiwahab, Maha K Abu Radwan, Abdalfattah Sabra, Mona Mohammed, Sarah El-Sayegh, Dina Abdel Rasoul Helal, Mahmoud E Kamal, Ahmed Hassan and 1 more

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Review in International journal of emergency medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Y F ShamseldinDepartment of Clinical Pharmacy, College of Pharmaceutical Sciences and Drug Manufacturing, Misr University for Science and Technology, Giza, Egypt. yasmine.shamseldin@must.edu.eg.ORCID http://orcid.org/0000-0002-7270-2293
Heba KhaledDepartment of Biochemistry, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
Muhammed AbdiwahabTanta University Hospitals, Tanta, Egypt.ORCID http://orcid.org/0009-0002-4032-5814
Maha K Abu RadwanPrincess Muna College of Nursing, Mutha University, Mutha, Jordan.
Abdalfattah SabraAl-Zagazig University AL Zagazig, Zagazig, Egypt.
Mona MohammedPediatric resident Doctor at National Nutrition Institute, Cairo, Egypt.
Sarah El-SayeghDepartment of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Dina Abdel Rasoul HelalDepartment of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Mahmoud E KamalClinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Egyptian Russian University, Cairo, Egypt.ORCID http://orcid.org/0000-0003-3253-8588
Ahmed HassanDepartment of Clinical Pharmacy, Faculty of Pharmacy, University of Sadat City, Sadat City, Menoufia, 32897, Egypt.ORCID http://orcid.org/0000-0003-0078-0310
Ahmed AzzamDepartment of Microbiology and Immunology, Faculty of Pharmacy, Helwan University, Cairo, Egypt.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEarly antibiotic exposure in preterm infants may disrupt gut microbiome development, affecting health. However, its link to late-onset sepsis (LOS) remains unclear. This meta-analysis aims to clarify the association while addressing confounding bias.

methodsThis systematic review and meta-analysis, conducted per PRISMA guidelines, utilized PubMed, Scopus, Google Scholar, and Web of Science for comprehensive literature retrieval. Studies comparing preterm infants with sterile blood cultures who received early antibiotics (short or prolonged) to those without, using LOS as the primary outcome, were included. Comparisons between short- and prolonged-course antibiotics were also considered. Only studies with adjusted analyses for confounders were considered. Adjusted odds ratios (aOR) were meta-analyzed, and the prediction interval (PI) was calculated using R software.

resultsTen studies met the eligibility criteria, comprising a total sample size of 55,089 preterm infants. Among these, nine studies included 33,549 preterm infants and compared prolonged antibiotic exposure to short exposure. Prolonged exposure was not significantly associated with LOS (pooled aOR = 1.2, 95% CI 0.99-1.46, P = 0.066, PI = 0.66 to 2.19, I² = 67%). Limiting the analysis to five studies with sample sizes over 1,000 reduced heterogeneity (I² = 30%) and provided a more precise confidence interval (pooled aOR = 1.03, 95% CI 0.91-1.15). Four studies, involving 41,938 preterm infants, examined preterm infants exposed to prolonged antibiotics versus those not exposed and found no significant association (aOR = 0.91, 95% CI 0.82-1.02, P = 0.1, PI = 0.72 to 1.16, I² = 0). All four studies had sample sizes exceeding 1,000. Additionally, these studies compared preterm infants with short antibiotic exposure to non-exposure, revealing a slightly lower risk of LOS (aOR = 0.87, 95% CI 0.77-0.98, P = 0.024, I² = 0) and a PI of 0.76 to 1.14.

conclusionsOur findings indicate that prolonged early antibiotic exposure in preterm infants with sterile cultures does not significantly increase the risk of LOS compared to no antibiotic exposure. Interestingly, a shorter duration of antibiotic exposure might be associated with a slightly lower risk of LOS.

Indexed as

Early antibiotic exposureLate-onset sepsisMeta-analysisPreterm infants

Identifiers

PMID40251478
PMCPMC12007201

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.