Neonatal Escherichia coli Bloodstream Infections. Issue 9 (September 2015)

• Record Type: Journal Article
• Authors: Bergin, Stephen P.; Thaden, Joshua T.; Ericson, Jessica E.; Cross, Heather; Messina, Julia; Clark, Reese H.; Fowler, Vance G.; Benjamin, Daniel K.; Hornik, Christoph P.; Smith, P. Brian
• Is Part Of: Pediatric infectious disease journal. Volume 34:Issue 9(2015)
• Publication Date: 2015-09
• Subjects: Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000000769
• Languages: English
• ISSNs: 0891-3668

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background:</title> <p> <italic>Escherichia coli</italic> is a common cause of bloodstream infections (BSIs) in infants and is associated with high mortality and morbidity among survivors. The clinical significance of antibiotic resistance and timing of appropriate antimicrobial therapy in this population is poorly understood.</p> </sec> <sec> <title>Methods:</title> <p>We identified all infants with <italic>E. coli</italic> BSIs discharged from 77 neonatal intensive care units managed by the Pediatrix Medical Group in 2012. We used multivariable logistic regression to evaluate the association between 30-day mortality and ampicillin-resistant <italic>E. coli</italic> BSI, as well as the number of active empiric antimicrobial agents administered, controlling for gestational age, small-for-gestational age status, early-onset versus late-onset BSI, oxygen requirement, ventilator support and inotropic support on the day of the first positive blood culture.</p> </sec> <sec> <title>Results:</title> <p>We identified 258 episodes of <italic>E. coli</italic> BSI, including 123 (48%) ampicillin-resistant isolates. Unadjusted 30-day mortality did not significantly differ between infants with ampicillin-resistant versus ampicillin-susceptible <italic>E. coli</italic> BSI [11 of 123 (9%) vs. 7 of 135 (5%); <italic>P</italic> = 0.33; adjusted odds ratio = 1.37 (95% confidence interval: 0.39, 4.77)]. Among ampicillin-resistant <italic>E. coli</italic> BSIs, 30-day mortality was not significantly lower for infants treated with at least one empiric antimicrobial active against ampicillin-resistant <italic>E. coli</italic> versus infants receiving no active empiric agent [adjusted odds ratio = 1.50 (0.07, 33.6)].</p> </sec> <sec> <title>Conclusions:</title> <p>In this population of infants with <italic>E. coli</italic> BSI, ampicillin resistance was not associated with significantly increased mortality. Among the subset of infants with ampicillin-resistant <italic>E. coli</italic>, appropriate empirical antibiotic therapy was not associated with lower mortality.</p> </sec> </abstract>