Christopher Woll1, Mark I Neuman2, Christopher M Pruitt3, Marie E Wang4, Eugene D Shapiro5, Samir S Shah6, Russell J McCulloh7, Lise E Nigrovic2, Sanyukta Desai8, Adrienne G DePorre9, Rianna C Leazer10, Richard D Marble11, Fran Balamuth12, Elana A Feldman13, Laura F Sartori14, Whitney L Browning15, Paul L Aronson16. 1. Department of Pediatrics and of Emergency Medicine, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, CT. 2. Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA. 3. Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL. 4. Division of Pediatric Hospital Medicine, Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA. 5. Departments of Pediatrics and of Epidemiology of Microbial Diseases, Yale University, New Haven, CT. 6. Divisions of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH. 7. Division of Infectious Diseases, Children's Mercy Hospital, Kansas City, MO; Hospital Medicine, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO. 8. Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH. 9. Hospital Medicine, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO. 10. Division of Hospital Medicine, Children's Hospital of The King's Daughters, Norfolk, VA. 11. Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL. 12. Division of Emergency Medicine and Center for Pediatric Clinical Effectiveness, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 13. University of Washington School of Medicine, Seattle, WA. 14. Division of Pediatric Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN. 15. Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, TN. 16. Department of Pediatrics and of Emergency Medicine, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, CT. Electronic address: paul.aronson@yale.edu.
Abstract
OBJECTIVES: To help guide empiric treatment of infants ≤60 days old with suspected invasive bacterial infection by describing pathogens and their antimicrobial susceptibilities. STUDY DESIGN: Cross-sectional study of infants ≤60 days old with invasive bacterial infection (bacteremia and/or bacterial meningitis) evaluated in the emergency departments of 11 children's hospitals between July 1, 2011 and June 30, 2016. Each site's microbiology laboratory database or electronic medical record system was queried to identify infants from whom a bacterial pathogen was isolated from either blood or cerebrospinal fluid. Medical records of these infants were reviewed to confirm the presence of a pathogen and to obtain demographic, clinical, and laboratory data. RESULTS: Of the 442 infants with invasive bacterial infection, 353 (79.9%) had bacteremia without meningitis, 64 (14.5%) had bacterial meningitis with bacteremia, and 25 (5.7%) had bacterial meningitis without bacteremia. The peak number of cases of invasive bacterial infection occurred in the second week of life; 364 (82.4%) infants were febrile. Group B streptococcus was the most common pathogen identified (36.7%), followed by Escherichia coli (30.8%), Staphylococcus aureus (9.7%), and Enterococcus spp (6.6%). Overall, 96.8% of pathogens were susceptible to ampicillin plus a third-generation cephalosporin, 96.0% to ampicillin plus gentamicin, and 89.2% to third-generation cephalosporins alone. CONCLUSIONS: For most infants ≤60 days old evaluated in a pediatric emergency department for suspected invasive bacterial infection, the combination of ampicillin plus either gentamicin or a third-generation cephalosporin is an appropriate empiric antimicrobial treatment regimen. Of the pathogens isolated from infants with invasive bacterial infection, 11% were resistant to third-generation cephalosporins alone.
OBJECTIVES: To help guide empiric treatment of infants ≤60 days old with suspected invasive bacterial infection by describing pathogens and their antimicrobial susceptibilities. STUDY DESIGN: Cross-sectional study of infants ≤60 days old with invasive bacterial infection (bacteremia and/or bacterial meningitis) evaluated in the emergency departments of 11 children's hospitals between July 1, 2011 and June 30, 2016. Each site's microbiology laboratory database or electronic medical record system was queried to identify infants from whom a bacterial pathogen was isolated from either blood or cerebrospinal fluid. Medical records of these infants were reviewed to confirm the presence of a pathogen and to obtain demographic, clinical, and laboratory data. RESULTS: Of the 442 infants with invasive bacterial infection, 353 (79.9%) had bacteremia without meningitis, 64 (14.5%) had bacterial meningitis with bacteremia, and 25 (5.7%) had bacterial meningitis without bacteremia. The peak number of cases of invasive bacterial infection occurred in the second week of life; 364 (82.4%) infants were febrile. Group B streptococcus was the most common pathogen identified (36.7%), followed by Escherichia coli (30.8%), Staphylococcus aureus (9.7%), and Enterococcus spp (6.6%). Overall, 96.8% of pathogens were susceptible to ampicillin plus a third-generation cephalosporin, 96.0% to ampicillin plus gentamicin, and 89.2% to third-generation cephalosporins alone. CONCLUSIONS: For most infants ≤60 days old evaluated in a pediatric emergency department for suspected invasive bacterial infection, the combination of ampicillin plus either gentamicin or a third-generation cephalosporin is an appropriate empiric antimicrobial treatment regimen. Of the pathogens isolated from infants with invasive bacterial infection, 11% were resistant to third-generation cephalosporins alone.
Authors: Eduardo Fleischer; Mark I Neuman; Marie E Wang; Lise E Nigrovic; Sanyukta Desai; Adrienne G DePorre; Rianna C Leazer; Richard D Marble; Laura F Sartori; Paul L Aronson Journal: Hosp Pediatr Date: 2019-11-05
Authors: Paul L Aronson; Marie E Wang; Eugene D Shapiro; Samir S Shah; Adrienne G DePorre; Russell J McCulloh; Christopher M Pruitt; Sanyukta Desai; Lise E Nigrovic; Richard D Marble; Rianna C Leazer; Sahar N Rooholamini; Laura F Sartori; Fran Balamuth; Christopher Woll; Mark I Neuman Journal: Pediatrics Date: 2018-11-13 Impact factor: 7.124
Authors: Paul L Aronson; Veronika Shabanova; Eugene D Shapiro; Marie E Wang; Lise E Nigrovic; Christopher M Pruitt; Adrienne G DePorre; Rianna C Leazer; Sanyukta Desai; Laura F Sartori; Richard D Marble; Sahar N Rooholamini; Russell J McCulloh; Christopher Woll; Fran Balamuth; Elizabeth R Alpern; Samir S Shah; Derek J Williams; Whitney L Browning; Nipam Shah; Mark I Neuman Journal: Pediatrics Date: 2019-06-05 Impact factor: 7.124
Authors: Lyubina C Yankova; Mark I Neuman; Marie E Wang; Christopher Woll; Adrienne G DePorre; Sanyukta Desai; Laura F Sartori; Lise E Nigrovic; Christopher M Pruitt; Richard D Marble; Rianna C Leazer; Sahar N Rooholamini; Fran Balamuth; Paul L Aronson Journal: Hosp Pediatr Date: 2020-12
Authors: Sanyukta Desai; Paul L Aronson; Veronika Shabanova; Mark I Neuman; Frances Balamuth; Christopher M Pruitt; Adrienne G DePorre; Lise E Nigrovic; Sahar N Rooholamini; Marie E Wang; Richard D Marble; Derek J Williams; Laura Sartori; Rianna C Leazer; Christine Mitchell; Samir S Shah Journal: Pediatrics Date: 2019-08-20 Impact factor: 7.124
Authors: Elizabeth R Alpern; Nathan Kuppermann; Stephen Blumberg; Genie Roosevelt; Andrea T Cruz; Lise E Nigrovic; Lorin R Browne; John M VanBuren; Octavio Ramilo; Prashant Mahajan Journal: Hosp Pediatr Date: 2020-09
Authors: Christopher M Pruitt; Mark I Neuman; Samir S Shah; Veronika Shabanova; Christopher Woll; Marie E Wang; Elizabeth R Alpern; Derek J Williams; Laura Sartori; Sanyukta Desai; Rianna C Leazer; Richard D Marble; Russell J McCulloh; Adrienne G DePorre; Sahar N Rooholamini; Catherine E Lumb; Fran Balamuth; Sarah Shin; Paul L Aronson Journal: J Pediatr Date: 2018-10-05 Impact factor: 4.406
Authors: Marie E Wang; Mark I Neuman; Lise E Nigrovic; Christopher M Pruitt; Sanyukta Desai; Adrienne G DePorre; Laura F Sartori; Richard D Marble; Christopher Woll; Rianna C Leazer; Fran Balamuth; Sahar N Rooholamini; Paul L Aronson Journal: Hosp Pediatr Date: 2020-12-14