Antimicrobial Susceptibility Profiles Among Neonatal Early-onset Sepsis Pathogens. Issue 3 (26th November 2021)

• Record Type: Journal Article
• Authors: Flannery, Dustin D.; Puopolo, Karen M.; Hansen, Nellie I.; Gerber, Jeffrey S.; Sánchez, Pablo J.; Stoll, Barbara J.
• Other Names: other.
• Is Part Of: Pediatric infectious disease journal. Volume 41:Issue 3(2022)
• Page Start: 263
• Page End: 271
• Publication Date: 2021-11-26
• Subjects: neonatal sepsis -- antimicrobial resistance -- empiric; Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000003380
• Languages: English
• ISSNs: 0891-3668

Abstract

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.