Dustin D Flannery1,2,3, Karen M Puopolo1,2,3, Nellie I Hansen4, Jeffrey S Gerber2,3,5, Pablo J Sánchez6, Barbara J Stoll7. 1. From the Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA. 2. Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 3. Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA. 4. Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC. 5. Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA. 6. Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH. 7. Department of Pediatrics, Emory University, Atlanta, GA.
Abstract
BACKGROUND: Empiric administration of ampicillin and gentamicin is recommended for newborns at risk of early-onset sepsis (EOS). There are limited data on antimicrobial susceptibility of all EOS pathogens. METHODS: Retrospective review of antimicrobial susceptibility data from a prospective EOS surveillance study of infants born ≥22 weeks' gestation and cared for in Neonatal Research Network centers April 2015-March 2017. Nonsusceptible was defined as intermediate or resistant on final result. RESULTS: We identified 239 pathogens (235 bacteria, 4 fungi) in 235 EOS cases among 217,480 live-born infants. Antimicrobial susceptibility data were available for 189/239 (79.1%) isolates. Among 81 Gram-positive isolates with ampicillin and gentamicin susceptibility data, all were susceptible in vitro to either ampicillin or gentamicin. Among Gram-negative isolates with ampicillin and gentamicin susceptibility data, 72/94 (76.6%) isolates were nonsusceptible to ampicillin, 8/94 (8.5%) were nonsusceptible to gentamicin, and 7/96 (7.3%) isolates were nonsusceptible to both. Five percent or less of tested Gram-negative isolates were nonsusceptible to each of third or fourth generation cephalosporins, piperacillin-tazobactam, and carbapenems. Overall, we estimated that 8% of EOS cases were caused by isolates nonsusceptible to both ampicillin and gentamicin; these were most likely to occur among preterm, very-low birth weight infants. CONCLUSIONS: The vast majority of contemporary EOS pathogens are susceptible to the combination of ampicillin and gentamicin. Clinicians may consider the addition of broader-spectrum therapy among newborns at highest risk of EOS, but we caution that neither the substitution nor the addition of 1 single antimicrobial agent is likely to provide adequate empiric therapy in all cases.
BACKGROUND: Empiric administration of ampicillin and gentamicin is recommended for newborns at risk of early-onset sepsis (EOS). There are limited data on antimicrobial susceptibility of all EOS pathogens. METHODS: Retrospective review of antimicrobial susceptibility data from a prospective EOS surveillance study of infants born ≥22 weeks' gestation and cared for in Neonatal Research Network centers April 2015-March 2017. Nonsusceptible was defined as intermediate or resistant on final result. RESULTS: We identified 239 pathogens (235 bacteria, 4 fungi) in 235 EOS cases among 217,480 live-born infants. Antimicrobial susceptibility data were available for 189/239 (79.1%) isolates. Among 81 Gram-positive isolates with ampicillin and gentamicin susceptibility data, all were susceptible in vitro to either ampicillin or gentamicin. Among Gram-negative isolates with ampicillin and gentamicin susceptibility data, 72/94 (76.6%) isolates were nonsusceptible to ampicillin, 8/94 (8.5%) were nonsusceptible to gentamicin, and 7/96 (7.3%) isolates were nonsusceptible to both. Five percent or less of tested Gram-negative isolates were nonsusceptible to each of third or fourth generation cephalosporins, piperacillin-tazobactam, and carbapenems. Overall, we estimated that 8% of EOS cases were caused by isolates nonsusceptible to both ampicillin and gentamicin; these were most likely to occur among preterm, very-low birth weight infants. CONCLUSIONS: The vast majority of contemporary EOS pathogens are susceptible to the combination of ampicillin and gentamicin. Clinicians may consider the addition of broader-spectrum therapy among newborns at highest risk of EOS, but we caution that neither the substitution nor the addition of 1 single antimicrobial agent is likely to provide adequate empiric therapy in all cases.
Authors: Barbara J Stoll; Nellie I Hansen; Rosemary D Higgins; Avroy A Fanaroff; Shahnaz Duara; Ronald Goldberg; Abbot Laptook; Michelle Walsh; William Oh; Ellen Hale Journal: Pediatr Infect Dis J Date: 2005-07 Impact factor: 2.129
Authors: C Michael Cotten; Scott McDonald; Barbara Stoll; Ronald N Goldberg; Kenneth Poole; Daniel K Benjamin Journal: Pediatrics Date: 2006-08 Impact factor: 7.124
Authors: Barbara J Stoll; Nellie I Hansen; Edward F Bell; Seetha Shankaran; Abbot R Laptook; Michele C Walsh; Ellen C Hale; Nancy S Newman; Kurt Schibler; Waldemar A Carlo; Kathleen A Kennedy; Brenda B Poindexter; Neil N Finer; Richard A Ehrenkranz; Shahnaz Duara; Pablo J Sánchez; T Michael O'Shea; Ronald N Goldberg; Krisa P Van Meurs; Roger G Faix; Dale L Phelps; Ivan D Frantz; Kristi L Watterberg; Shampa Saha; Abhik Das; Rosemary D Higgins Journal: Pediatrics Date: 2010-08-23 Impact factor: 7.124
Authors: Barbara J Stoll; Karen M Puopolo; Nellie I Hansen; Pablo J Sánchez; Edward F Bell; Waldemar A Carlo; C Michael Cotten; Carl T D'Angio; S Nadya J Kazzi; Brenda B Poindexter; Krisa P Van Meurs; Ellen C Hale; Monica V Collins; Abhik Das; Carol J Baker; Myra H Wyckoff; Bradley A Yoder; Kristi L Watterberg; Michele C Walsh; Uday Devaskar; Abbot R Laptook; Gregory M Sokol; Stephanie J Schrag; Rosemary D Higgins Journal: JAMA Pediatr Date: 2020-07-06 Impact factor: 16.193
Authors: Dustin D Flannery; Rachael K Ross; Sagori Mukhopadhyay; Alison C Tribble; Karen M Puopolo; Jeffrey S Gerber Journal: JAMA Netw Open Date: 2018-05-18