Empiric Antibiotics for Serious Bacterial Infection in Young Infants. Issue 8 (August 2015)

• Record Type: Journal Article
• Authors: Cantey, Joseph B.; Lopez-Medina, Eduardo; Nguyen, Sean; Doern, Christopher; Garcia, Carla
• Is Part Of: Pediatric emergency care. Volume 31:Issue 8(2015)
• Publication Date: 2015-08
• Subjects: Pediatric emergencies -- Periodicals; 618.92002505
• DOI: 10.1097/PEC.0000000000000400
• Languages: English
• ISSNs: 0749-5161

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objectives</title> <p>To evaluate the causative agents of serious bacterial infection (SBI) in young infants and the optimal approach to empiric antibiotic therapy for infants with SBI.</p> </sec> <sec> <title>Methods</title> <p>From May 1, 2011, to December 1, 2013, pertinent clinical data were collected on previously well infants 60 days or younger with SBI as defined by a positive bacterial culture from a sterile site. Infants were identified by prospective surveillance of admissions and daily review of microbiology records.</p> </sec> <sec> <title>Results</title> <p>Two hundred sixty-five infants with SBI were identified. Mean age was 32 days (SD ±16.6 days). Twenty-nine infants had meningitis, 66 had bacteremia (37 with concomitant urinary tract infection), and 170 had urinary tract infection alone. No methicillin-resistant <italic>Staphylococcus aureus</italic>, vancomycin-resistant <italic>Enterococcus</italic> sp., or penicillin-resistant <italic>Streptococcus pneumoniae</italic> were identified. Four extended-spectrum β-lactamase–producing gram-negative bacilli were seen. Empiric therapy was ampicillin and gentamicin (n = 116, 44%) or third-generation cephalosporin based (n = 149, 56%). Ampicillin and gentamicin, with third-generation cephalosporins reserved for cases where meningitis is suspected, would have provided effective coverage for 98.5% of infants and unnecessarily broad therapy for 4.3%. Third-generation cephalosporins with ampicillin would have been effective for 98.5% of infants and unnecessarily broad for 83.8%. Third-generation cephalosporin monotherapy was less effective than either combination (<italic>P</italic> < 0.001). Fifty-seven percent of broad spectrum empiric therapy was continued despite culture results allowing de-escalation.</p> </sec> <sec> <title>Conclusions</title> <p>Ampicillin/gentamicin remains an effective empiric regimen for infants 60 days or younger with suspected SBI. Use of a third-generation cephalosporin for suspected meningitis is appropriate, but cerebrospinal fluid must be obtained promptly to guide appropriate therapy.</p> </sec> </abstract>