{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T02:49:17Z","timestamp":1777344557671,"version":"3.51.4"},"reference-count":23,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,2,21]],"date-time":"2021-02-21T00:00:00Z","timestamp":1613865600000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Study Objective<\/jats:title><jats:p>Little guidance exists on the treatment duration of culture\u2010negative early\u2010onset sepsis (CN\u2010EOS) in neonates, which may lead to prolonged antimicrobial therapy and adverse outcomes. Our objective was to identify risk factors associated with prolonged antibiotic therapy in CN\u2010EOS in neonates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>This was a retrospective, matched cohort study of neonates treated with empiric antibiotic therapy for EOS. Infants were sampled with matching of gestational age (GA) into short (\u22643\u00a0days) and prolonged (&gt;3\u00a0days) antibiotic course. Primary outcomes were to identify predictive factors that may be associated with prolonged therapy and compare rates of late\u2010onset sepsis (LOS) and mortality. Secondary outcomes included necrotizing enterocolitis, feeding intolerance, and early development assessment. Predictors associated with prolonged antibiotic therapy were identified using multivariable\u2010adjusted logistic regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements and Main Results<\/jats:title><jats:p>Three hundred infants were included with 150 infants in each group. Mean GA and birthweights were 34.2\u00a0\u00b1\u00a04.7\u00a0weeks and 2293\u00a0\u00b1\u00a0991\u00a0g, respectively. Male gender, 5\u2010min Apgar &lt;7, immature\u2010to\u2010total neutrophil ratio \u22650.2, C\u2010reactive protein (CRP) \u226510\u00a0mg\/L, need for vasopressors, and mechanical ventilation were identified as significant predictors for prolonged antibiotics in all infants. Independent of GA, elevated CRP (OR 40.84, 95% CI 15.28\u2013109.15, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001), need for vasopressors (OR 13.48, 95% CI 3.86\u201347.15, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001), and mechanical ventilation (OR 12.98, 95% CI 4.91\u201334.35, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001) remained significant predictors of prolonged antibiotic use. Infants in the prolonged courses experienced significant delays in achieving independent oral feeding compared with infants receiving short\u2010course antibiotics (median 17.5 vs. 8\u00a0days, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.002, respectively). There were no significant differences in LOS, mortality, or other neonatal comorbidities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Elevated CRP levels, need for vasopressors, and mechanical ventilation were associated with prolonged antibiotic use in neonates presumptively treated for CN\u2010EOS. Further research is warranted in identifying selective biomarkers for EOS and evaluating whether early antibiotic discontinuation for CN\u2010EOS, despite abnormal laboratory tests\/illness severity, is safe and justified.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.2507","type":"journal-article","created":{"date-parts":[[2021,2,3]],"date-time":"2021-02-03T18:16:45Z","timestamp":1612376205000},"page":"148-161","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Factors influencing antibiotic duration in culture\u2010negative neonatal early\u2010onset sepsis"],"prefix":"10.1002","volume":"41","author":[{"given":"Corinne N.","family":"Songer","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice College of Pharmacy University of Illinois at Chicago Chicago Illinois USA"},{"name":"Children\u2019s Hospital University of Illinois University of Illinois Hospital &amp; Health Sciences System Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7744-3518","authenticated-orcid":false,"given":"Gregory S.","family":"Calip","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Systems College of Pharmacy, Outcomes and Policy University of Illinois at Chicago Chicago Illinois USA"},{"name":"Flatiron Health New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nishant","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital University of Illinois University of Illinois Hospital &amp; Health Sciences System Chicago Illinois USA"},{"name":"Department of Pediatrics Division of Neonatology University of Illinois at Chicago Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa M.","family":"Barbosa","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital University of Illinois University of Illinois Hospital &amp; Health Sciences System Chicago Illinois USA"},{"name":"Department of Occupational Therapy College of Applied Health University of Illinois at Chicago Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3791-2965","authenticated-orcid":false,"given":"Jennifer T.","family":"Pham","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice College of Pharmacy University of Illinois at Chicago Chicago Illinois USA"},{"name":"Children\u2019s Hospital University of Illinois University of Illinois Hospital &amp; Health Sciences System Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,2,21]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00031-13"},{"key":"e_1_2_7_3_1","unstructured":"Group B Strep.Centers for Disease Control and Prevention website.https:\/\/www.cdc.gov\/groupbstrep\/clinicians\/index.html. 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