Abstract
Purpose :
Retinopathy of prematurity (ROP) has previously been linked to neonatal sepsis, with prolonged antibiotic use suggested as a potential connection. However, investigations on the direct association between antibiotic use and ROP have been limited. Given the role of antibiotics in gut dysbiosis and growing evidence of a gut-retina axis, we assessed whether exposure to different antibiotic classes is associated with incidence of ROP requiring treatment.
Methods :
Retrospective analysis was performed on preterm infants born at the University of Chicago Medicine who were screened for ROP between January 2016 and May 2023. The primary outcome measure was severe ROP requiring treatment. Exposure to antibiotic classes within the first 6 months of life was determined, and logistic regression analysis was used to evaluate associations between treated ROP and systemic antibiotic exposure. Multivariable logistic regression adjusted for birth weight (BW), gestational age (GA), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), sepsis, other bacterial infections, candidiasis, cytomegaloviremia, and herpes simplex virus.
Results :
A total of 1,035 patients were included, with 54 treated for ROP (5.2%). Compared to cases not requiring treatment, the ROP treatment group showed lower BWs (p < 0.0001), younger GAs (p < 0.0001), and higher rates of BPD (p < 0.001), IVH (p < 0.001), and bacterial infection (p < 0.05). No association was noted with NEC. After multivariable adjustment, administration of cephalosporins/carbapenems/monobactams (OR 5.13, CI 2.57 - 10.23) was significantly associated with treatment of ROP, and antifungals (OR 2.80, CI 0.91 - 8.64) trended towards significance. There was no significant association on multivariable adjustment with penicillins, aminoglycosides, or other antibacterial drugs such as vancomycin.
Conclusions :
Early exposure to specific antibiotic classes, particularly cephalosporins, carbapenems, and monobactams, may be associated with treatment-necessary ROP. Given the antibiotic classes’ broad-spectrum coverage and continued significance after adjusting for sepsis and NEC, this association may be driven by gut dysbiosis. Future studies are needed to clarify this relationship and potential mechanisms of action.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.