This study, conducted for the first time in Qatar, systematically analyzed the determinants of prolonged antibiotic therapy in early-onset neonatal meningitis suspects with negative cerebrospinal fluid (CSF) cultures. Through retrospective cohort analysis, it identified multiple independent predictive factors including low Apgar score, positive blood culture, traumatic lumbar puncture, CRP ≥ 50 mg/L, elevated CSF white blood cell count, and delayed lumbar puncture. These findings provide critical references for clinical strategies in antibiotic use under uncertain conditions, contributing to optimized antimicrobial stewardship and reduced unnecessary exposure.
Literature Overview
This article titled 'Determinants of Prolonged Antibiotic Administration in Culture-Negative Evaluations of Early-Onset Neonatal Meningitis: A Retrospective Cohort Study' published in the journal Antibiotics reviews clinical determinants of prolonged antibiotic therapy in early-onset neonatal meningitis suspects without definitive bacterial infection evidence. Using multivariable analysis, the study identified multiple significant biomarkers and clinical features influencing treatment duration, including low birth weight, preterm birth, low Apgar score, respiratory support requirements, and elevated CSF protein levels. It emphasizes optimizing antibiotic use through clinical and laboratory indicators in the absence of unified diagnostic criteria. The analysis included 315 neonates without positive CSF cultures but receiving antibiotic treatment, with 30.5% of patients undergoing treatment exceeding 7 days.
Background Knowledge
Early-onset neonatal meningitis (EONM) represents high-risk yet rare infectious conditions where diagnosis is complicated by non-specific clinical presentations and negative CSF cultures. Despite negative blood cultures and normal CSF parameters in most cases, clinicians often prolong antibiotic use due to concerns about partially treated meningitis. This study fills the research gap in Qatar regarding such clinical decisions by analyzing multiple potential influencing factors including low Apgar score, traumatic lumbar puncture, CRP levels, and CSF white blood cell counts to provide evidence-based support for antimicrobial stewardship.
Research Methods and Experiments
Conducted at the Women's Health and Research Center in Doha, Qatar, this retrospective study included neonates undergoing lumbar puncture between 2015-2018. Among 9,242 newborns, 345 received lumbar punctures with 315 meeting analysis criteria. Variables analyzed included birth weight, gestational age, Apgar scores, respiratory support requirements, laboratory tests (CRP, blood cultures, CSF protein and white blood cell counts), and lumbar puncture characteristics (delayed or traumatic). Multivariable logistic regression was used to identify independent predictors.
Key Conclusions and Perspectives
Research Significance and Prospects
The findings highlight how clinicians integrate neonatal clinical status and laboratory data to determine antibiotic duration when CSF cultures are negative. Identifying these predictors enables risk-stratified treatment strategies and promotes rational antimicrobial use. Future research should explore multi-center cohorts with prospective data collection and develop standardized decision-support tools to reduce unnecessary antibiotic exposure and optimize neonatal antimicrobial management.
Conclusion
This study systematically analyzed how neonatal clinical features and laboratory markers influence antibiotic decisions in absence of definitive bacterial infection evidence. Low Apgar score, low birth weight, respiratory support requirements, elevated CRP levels, and increased CSF white blood cell counts were all significantly associated with prolonged antibiotic use. The research suggests that while clinicians may extend treatment as precautionary measures, this practice increases antimicrobial exposure risks, necessitating standardized decision-making protocols to optimize antimicrobial stewardship and prevent overtreatment.
