Aim: To identify specific antimicrobial agents associated with the development of necrotizing enterocolitis in critically ill neonates, and to characterize independent clinical and demographic factors associated with its occurrence in this vulnerable population.
Study Design: This retrospective cohort study included neonates admitted for more than 24 hours to a Brazilian neonatal intensive care unit between January 2020 and December 2021. Only cases of necrotizing enterocolitis classified as Bell stage IIA or higher were analyzed. Antimicrobial exposure was assessed by days of therapy, considering only agents administered before the diagnosis of necrotizing enterocolitis. Univariate and multivariate logistic regression analyses were performed.
Results: Among 594 neonates included, 15 developed necrotizing enterocolitis (incidence: 1.7%). Meropenem exposure was significantly associated with necrotizing enterocolitis (adjusted OR 3.74; 95% CI: 1.14–12.2; p = 0.03). Additional associated factors included lower gestational age, lower birth weight, presence of congenital heart disease, Methicillin-Resistant Staphylococcus aureu detection in blood culture, and prolonged hospitalization. No evidence of multicollinearity was found among variables.
Conclusion: Meropenem exposure prior to necrotizing enterocolitis onset was associated with a higher likelihood of necrotizing enterocolitis risk of the disease. The findings reinforce the importance of judicious use of broad-spectrum antibiotics and careful monitoring of antimicrobial stewardship in neonatal units.