In Utero Exposure to Antibiotics and Risk of Serious Infections in the First Year of Life.

IF 4 2区 医学 Q1 PHARMACOLOGY & PHARMACY Drug Safety Pub Date : 2024-05-01 Epub Date: 2024-02-26 DOI:10.1007/s40264-024-01401-z
Mylène Tisseyre, Mathis Collier, Nathanaël Beeker, Florentia Kaguelidou, Jean-Marc Treluyer, Laurent Chouchana
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Abstract

Introduction and objective: Given the high prevalence of antibiotic prescription during pregnancy in France and previous studies suggesting an increased risk of infection in offspring with such exposures, our study aimed to investigate the association between prenatal exposure to systemic antibiotics and serious infections in full-term infants during their first year of life.

Methods: We conducted a retrospective population-based cohort study on singleton, full-term liveborn non-immunocompromised infants, using the French National Health Data System (SNDS) between 2012 and 2021. Systemic antibiotic dispensing in ambulatory care settings during pregnancy defined the exposure. Outcomes concerned serious infections (i.e., infections requiring hospitalization) in offspring identified between 3 and 12 months of life, hence excluding infections of maternal origin. Adjusted odds ratios (aORs) were estimated using logistic regression with multivariate models to control for potential confounders.

Results: Of 2,836,630 infants included, 39.6% were prenatally exposed to systemic antibiotics. Infants prenatally exposed to antibiotics had a higher incidence of serious infections compared with unexposed infants {aOR 1.12 [95% confidence interval (95% CI) 1.11-1.13]}. Similar associations were observed according to the timing of exposure during pregnancy, antibiotic class, and site of infections. The strongest association was observed when infants were prenatally exposed to three or more antibiotic courses during pregnancy [aOR 1.21 (95% CI 1.19-1.24)]. Limitations include residual confounders, such as genetic susceptibility to infections and the role of the underlying pathogen agent.

Conclusion: Prenatal exposure to systemic antibiotics is very common and is associated with a weak yet significant associations with subsequent serious infectious events during the first year of life. While our study revealed associations, it is important to note that causation cannot be established, given the acknowledged limitations, including potential confounding by indication.

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宫内接触抗生素与婴儿出生后第一年的严重感染风险。
引言和目的:鉴于法国妊娠期抗生素处方的高流行率,以及之前的研究表明此类暴露会增加后代的感染风险,我们的研究旨在调查产前全身性抗生素暴露与足月婴儿出生后第一年严重感染之间的关联:我们利用法国国家健康数据系统(SNDS)对2012年至2021年期间单胎、足月、非免疫力低下的活产婴儿进行了一项基于人群的回顾性队列研究。研究对象为孕期在门诊医疗机构接受系统抗生素治疗的婴儿。研究结果涉及出生后3至12个月的婴儿发生的严重感染(即需要住院治疗的感染),因此排除了母源性感染。采用逻辑回归和多变量模型估算调整后的几率比(aORs),以控制潜在的混杂因素:在纳入的 2,836,630 名婴儿中,39.6% 的婴儿在产前接触过全身性抗生素。与未接触过抗生素的婴儿相比,产前接触过抗生素的婴儿发生严重感染的几率更高{aOR 1.12 [95% 置信区间 (95% CI) 1.11-1.13]}。根据孕期接触抗生素的时间、抗生素类别和感染部位,也观察到了类似的关联。当婴儿在怀孕期间产前接触过三个或三个以上疗程的抗生素时,观察到的关联性最强[aOR 1.21 (95% CI 1.19-1.24)]。局限性包括残留的混杂因素,如对感染的遗传易感性和潜在病原体的作用:结论:产前接触全身性抗生素非常常见,与婴儿出生后第一年的严重感染事件有微弱但显著的相关性。虽然我们的研究揭示了相关性,但必须指出的是,由于公认的局限性,包括可能存在的适应症混淆,因此无法确定因果关系。
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来源期刊
Drug Safety
Drug Safety 医学-毒理学
CiteScore
7.60
自引率
7.10%
发文量
112
审稿时长
6-12 weeks
期刊介绍: Drug Safety is the official journal of the International Society of Pharmacovigilance. The journal includes: Overviews of contentious or emerging issues. Comprehensive narrative reviews that provide an authoritative source of information on epidemiology, clinical features, prevention and management of adverse effects of individual drugs and drug classes. In-depth benefit-risk assessment of adverse effect and efficacy data for a drug in a defined therapeutic area. Systematic reviews (with or without meta-analyses) that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. Original research articles reporting the results of well-designed studies in disciplines such as pharmacoepidemiology, pharmacovigilance, pharmacology and toxicology, and pharmacogenomics. Editorials and commentaries on topical issues. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in Drug Safety Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.
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