What’s the approach to positive ET culture? When should treat and when should it be avoided? While a negative culture is obviously desirable, how far should we pursue it? Will the side effects of antibiotics eventually outweigh their benefits?

We treat Ureaplasma colonisation with Azithromyzine, but no other colonisations.

Really interesting, it made me think. A couple of questions out of curiosity.

Are you giving azithromycin prophylactically after birth, or only once you have established CLD with a positive culture? I ask because the biological rationale was always strongest in that early post-birth inflammatory window, so I'd be interested to know how you're applying it in practice.

One thing that always gave me pause is that even in studies where azithromycin successfully eradicated Ureaplasma, it didn't seem to translate into a reduction in BPD, which suggests the lung injury may be driven by the early inflammatory cascade rather than ongoing colonisation. Possibly even beginning in utero.

The AZTEC trial came back negative, with a slight trend toward harm. It's made us revisit their approach.

Also worth thinking about, are you continuing probiotics during the course? Given the microbiome impact of macrolides in preterm infants.

Would be really curious to hear how you are finding it in practice.

Many thanks

I’ve only seen the approach were you find yourself with a problematic tube that need constant suctioning, and then you take a culture to see if there is Ureaplasma present that might(?) induce increased mucus production. If present, a course of azithromycin is provided.

However, a colleague mentioned that their previous unit abroad gave prophylactic azithromycin to all extreme preterms, both to target Ureaplasma and to leverage its anti-inflammatory effects.