Sameer J Patel1, Nicole Green1, Sarah A Clock1, David A Paul2, Jeffrey M Perlman3, Theoklis Zaoutis4, Yu-Hui Ferng5, Luis Alba1, Haomiao Jia5, Elaine L Larson5, Lisa Saiman1,6. 1. Department of Pediatrics, Columbia University Medical Center, New York, New York. 2. Department of Pediatrics, Section of Neonatology, Christiana Care Health System, Newark, Delaware. 3. Department of Pediatrics, Weill Cornell Medical Center, New York, New York. 4. Department of Pediatrics, Children's Hospital of Philadelphia, Pennsylvania. 5. School of Nursing, Columbia University Medical Center. 6. Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York.
Abstract
BACKGROUND: Gram-negative bacilli (GNB) account for a significant burden of infection and colonization in neonatal intensive care units (NICUs), and antibiotic resistance among these pathogens is of increasing concern. METHODS: A prospective cohort study was performed in 4 NICUs between May 2009 and April 2012. The body sites from which GNB were isolated, antimicrobial susceptibilities of the GNB isolated, and antimicrobial therapy were assessed. RESULTS: Attending neonatologists treated 3.0% (188 of 6184) of eligible infants for GNB infection; 23% of 214 GNB isolates were nonsusceptible to antimicrobial agents, including gentamicin (14.8%), piperacillin-tazobactam (9.9%), third-generation cephalosporin (7.0%), and/or carbapenem agents (4.5%). Gentamicin was the most commonly used antibiotic overall, and much of its use was empiric. However, third-generation cephalosporin agents and cefepime were used more commonly as targeted therapy for identified Gram-negative pathogens. CONCLUSIONS: One-quarter of the GNB isolates were nonsusceptible to ≥1 antibiotic. Antimicrobial stewardship strategies for reducing antimicrobial use in NICUs should be implemented.
BACKGROUND: Gram-negative bacilli (GNB) account for a significant burden of infection and colonization in neonatal intensive care units (NICUs), and antibiotic resistance among these pathogens is of increasing concern. METHODS: A prospective cohort study was performed in 4 NICUs between May 2009 and April 2012. The body sites from which GNB were isolated, antimicrobial susceptibilities of the GNB isolated, and antimicrobial therapy were assessed. RESULTS: Attending neonatologists treated 3.0% (188 of 6184) of eligible infants for GNB infection; 23% of 214 GNB isolates were nonsusceptible to antimicrobial agents, including gentamicin (14.8%), piperacillin-tazobactam (9.9%), third-generation cephalosporin (7.0%), and/or carbapenem agents (4.5%). Gentamicin was the most commonly used antibiotic overall, and much of its use was empiric. However, third-generation cephalosporin agents and cefepime were used more commonly as targeted therapy for identified Gram-negative pathogens. CONCLUSIONS: One-quarter of the GNB isolates were nonsusceptible to ≥1 antibiotic. Antimicrobial stewardship strategies for reducing antimicrobial use in NICUs should be implemented.
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