Efficacy and safety of short- vs. standard-course antibiotics for culture-negative neonatal sepsis: a systematic review and meta-analysis.

IF 1.8 4区医学 Q2 PEDIATRICS

Journal of Tropical Pediatrics Pub Date : 2024-02-07 DOI:10.1093/tropej/fmae002

Risha Devi, Mayank Priyadarshi, Poonam Singh, Suman Chaurasia, Sriparna Basu

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引用次数: 0

Abstract

Objectives: To conduct a systematic review and meta-analysis of evidence from randomized controlled trials (RCTs) comparing a short course of antibiotics (2-4 days), to a standard course (5-7 days), for the treatment of culture-negative neonatal sepsis.

Methods: Relevant databases were searched for RCTs comparing short- vs. standard-course of antibiotics for culture-negative sepsis. The primary outcomes were mortality and treatment failure, defined as the reappearance of clinical signs suggestive of sepsis within 7 days of stoppage of antibiotics. Secondary outcomes included neurological impairment, duration of hospital stay, need for oxygen, respiratory support and double-volume exchange transfusion (DVET).

Results: Seven RCTs were included in the review with 729 neonates >30 weeks gestational age at birth. No mortality occurred in either of the groups (2 studies; 276 neonates). Treatment failure rates were similar in the short- and standard-course antibiotic groups [7 studies; 729 neonates; risk ratio (RR) = 1.01; 95% confidence interval (CI), 0.55 to 1.86; very low certainty]. The short course of antibiotics resulted in a shorter hospital stay [3 studies; 293 neonates; mean difference (MD), -2.46 days; 95% CI, -3.16 to -1.75]. There was no difference in the need for oxygen supplementation (2 studies; 258 neonates; RR, 1.40; 95% CI, 0.40 to 4.91), any respiratory support (2 studies; 258 neonates; RR, 1.04; 95% CI, 0.92 to 1.17) or DVET (2 studies; 258 neonates; RR, 1.29; 95% CI, 0.56 to 2.95).

Conclusion: Very-low certainty evidence suggests that a short antibiotic course, compared to a standard course, does not affect treatment failure rates in culture-negative neonatal sepsis. There is a need for well-designed RCTs powered enough to assess critical outcomes such as mortality and neurological sequelae to generate stronger evidence and inform guidelines.

Prospero registration number: CRD42023437199.

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短期抗生素与标准疗程抗生素治疗培养阴性新生儿败血症的疗效和安全性：系统综述和荟萃分析。

研究目的对治疗培养阴性新生儿败血症的短期抗生素疗程（2-4 天）与标准疗程（5-7 天）的随机对照试验（RCT）证据进行系统回顾和荟萃分析：方法：在相关数据库中搜索了短期与标准疗程抗生素治疗培养阴性败血症的对比研究。主要结果是死亡率和治疗失败，治疗失败的定义是在停用抗生素 7 天内再次出现提示败血症的临床症状。次要结果包括神经功能损伤、住院时间、氧气需求、呼吸支持和双容量交换输血（DVET）：共有 729 名胎龄大于 30 周的新生儿接受了研究。两组均无死亡病例（2 项研究；276 名新生儿）。短期抗生素组和标准疗程抗生素组的治疗失败率相似[7 项研究；729 名新生儿；风险比 (RR) = 1.01；95% 置信区间 (CI)，0.55 至 1.86；确定性极低]。抗生素疗程短可缩短住院时间[3项研究；293名新生儿；平均差异（MD）：-2.46天；95% 置信区间（CI）：-3.16至-1.75]。在补氧需求（2 项研究；258 名新生儿；RR，1.40；95% CI，0.40 至 4.91）、任何呼吸支持（2 项研究；258 名新生儿；RR，1.04；95% CI，0.92 至 1.17）或 DVET（2 项研究；258 名新生儿；RR，1.29；95% CI，0.56 至 2.95）方面没有差异：极低确定性证据表明，与标准疗程相比，短期抗生素疗程不会影响培养阴性新生儿败血症的治疗失败率。有必要进行设计良好、有足够动力的 RCT 研究，以评估死亡率和神经系统后遗症等重要结果，从而获得更有力的证据并为指南提供参考：CRD42023437199。

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来源期刊

Journal of Tropical Pediatrics 医学-热带医学

CiteScore

4.00

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： The Journal of Tropical Pediatrics provides a link between theory and practice in the field. Papers report key results of clinical and community research, and considerations of programme development. More general descriptive pieces are included when they have application to work preceeding elsewhere. The journal also presents review articles, book reviews and, occasionally, short monographs and selections of important papers delivered at relevant conferences.