Restrictive prescription of antibiotics in preterm infants with premature rupture of membranes

Preterm infants with premature rupture of membranes are often administered antibiotic treatment, however, the rates of early onset sepsis are lower. A recent study, as per the national guidelines, implemented a stratified approach in the decision to start antibiotic treatment using maternal history, clinical impression and biomarkers and evaluated its results.

The study included all preterm newborns with rupture of membranes, at least 1 h before delivery, admitted to the tertiary neonatal intensive care unit, and extracted data on antibiotic exposure, mortality and major neonatal complications from the electronic patient charts. Further, the effects and safety of the stratified approach were evaluated.

The results were as follows-

• 456 infants met the inclusion criteria, among which 26% received primary antibiotics whereas 74% did not. 
• Of those receiving primary antibiotics, 11% had a blood culture positive sepsis, 38% met the criteria of clinical sepsis, and in the remaining 51% sepsis was ruled out and antibiotics were stopped after 48-96 h. 
• All infants with blood culture-positive sepsis were recognized and treated within the first 24 h of life using the aforementioned approach.
• None of the 336 infants who were not started on antibiotics primarily required antibiotic therapy within the first 5 days of life. 
• No deaths or major neonatal complications were reported in the group that did not receive empiric antibiotics.

This stratified approach for preterm infants with premature rupture of membranes permits a safe reduction of antibiotic exposure even in this high-risk population. Hence, only 25% of high-risk preterm newborns are treated with antibiotics of which >50% receive <5 days of treatment. To treat one infant with blood culture-positive sepsis, only 9 infants receive empiric antibiotics.

Armann J, Rüdiger M, Berner R. et al. Restrictive prescription of antibiotics in preterm infants with premature rupture of membranes. BMC Pediatr. 2022;22. https://doi.org/10.1186/s12887-022-03476-y