title: Anaerobic antimicrobial therapy after necrotizing enterocolitis in VLBW infants.
abstract: OBJECTIVE
  To evaluate the effect of anaerobic antimicrobial therapy for necrotizing enterocolitis (NEC) on clinical outcomes in very low birth weight (≤1500 g) infants.
  
  
  METHODS
  We identified very low birth weight infants with NEC from 348 US NICUs from 1997 to 2012. Anaerobic antimicrobial therapy was defined by antibiotic exposure on the first day of NEC. We matched (1:1) infants exposed to anaerobic antimicrobial therapy with infants who were not exposed by using a propensity score stratified by NEC severity (medical and surgical). The primary composite outcome was in-hospital death or intestinal stricture. We assessed the relationship between anaerobic antimicrobial therapy and outcome by using a conditional logistic regression on the matched cohort.
  
  
  RESULTS
  A total of 1390 infants exposed to anaerobic antimicrobial therapy were matched with 1390 infants not exposed. Mean gestational age and birth weight were 27 weeks and 946 g, respectively, and were similar in both groups. We found no significant difference in the combined outcome of death or strictures, but strictures as a single outcome were more common in the anaerobic antimicrobial therapy group (odds ratio 1.73; 95% confidence interval, 1.11-2.72). Among infants with surgical NEC, mortality was less common with anaerobic antimicrobial therapy (odds ratio 0.71; 95% confidence interval, 0.52-0.95).
  
  
  CONCLUSIONS
  Anaerobic antimicrobial therapy was not associated with the composite outcome of death or strictures but was associated with an increase in intestinal strictures. This higher incidence of intestinal strictures may be explained by the fact that death is a competing outcome for intestinal strictures, and mortality was slightly lower in the anaerobic cohort. Infants with surgical NEC who received anaerobic antimicrobial therapy had lower mortality.
authors.affiliation: Duke Clinical Research Institute, and.
authors.forename: Julie
authors.initials: J
authors.lastname: Autmizguine
authors.affiliation: Duke Clinical Research Institute, and Department of Pediatrics, Duke University Medical Center, Durham, North Carolina;
authors.forename: Christoph P
authors.initials: CP
authors.lastname: Hornik
authors.affiliation: Duke Clinical Research Institute, and Department of Pediatrics, Duke University Medical Center, Durham, North Carolina;
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
authors.affiliation: Division of Neonatal-Perinatal Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Laughon
authors.affiliation: Pediatrix-Obstetrix Center for Research and Education, Sunrise, Florida; and.
authors.forename: Reese H
authors.initials: RH
authors.lastname: Clark
authors.affiliation: Department of Pediatrics, Duke University Medical Center, Durham, North Carolina;
authors.forename: C Michael
authors.initials: CM
authors.lastname: Cotten
authors.affiliation: Duke Clinical Research Institute, and Department of Pediatrics, Duke University Medical Center, Durham, North Carolina;
authors.forename: Michael
authors.initials: M
authors.lastname: Cohen-Wolkowiez
authors.affiliation: John E. Walker Department of Economics, Clemson University, Clemson, South Carolina.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
authors.affiliation: Duke Clinical Research Institute, and Department of Pediatrics, Duke University Medical Center, Durham, North Carolina; brian.smith@duke.edu.
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
mesh_terms: D000890:Anti-Infective Agents / Q000009:adverse effects*; D001421:Bacteria, Anaerobic; D001424:Bacterial Infections / Q000188:drug therapy*; D020345:Enterocolitis, Necrotizing / Q000188:drug therapy* / Q000382:microbiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007415:Intestinal Obstruction / Q000139:chemically induced / Q000453:epidemiology; D008297:Male; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents
keywords: anaerobes; antibiotics; intestinal strictures; mortality; necrotizing enterocolitis; very low birth weight infants