Changing Trend of Empirical Antibiotic Regimen: Experience of Two Studies at Different Periods in a Neonatal Intensive Care Unit in Tehran, Iran
AbstractBacterial sepsis is one of the most common causes of mortality and morbidity in neonates. It has been recognized a gradual change in spectrum of organisms responsible for neonatal sepsis. In this study we have evaluated changing trend of incidence and antibiotic susceptibility in neonatal late - onset sepsis (LOS) in 2-periods. This study is based on results of blood culture in neonatal late-onset sepsis, in 2--periods study throughout 12 - years. Neonatal LOS was defined as clinical signs suggestive of infection with a positive blood culture (B/C) after 72 hrs of birth. During first study (period: 1990-1992), the most common bacteremia in LOS was staphylococcus aureus (staph aureus) (34%). Overall gram- negative bacteria (GNB) were the predominant organism (66%). It was shown that 60% of GNB were resisted to gentamicin and 3% to amikacin, while in case of gram-positive bacteria (GPB); about 95% were resisted to ampicillin and 28% to cephalothin. In the second study (period: 2004-2007), the vast majority (56.6%) of septic cases were caused by GNB. The most common cause of late- onset sepsis was klebsiela p. (31%). The GPB were resistant to cephalothin (90%). There has been a dramatic increase resistance to cephalothin and aminoglycosides and 3rd -generation cephalosporins. The combination of cephalothin plus amikacin in suspected LOS was no longer the effective therapeutic regimen in our neonatal intensive care unit (NICU). Now, it seems the best choice for empiric antibiotic regimen in suspected LOS is the combination vancomycin plus amikacin. Constant surveillance is important to guide empirical antibiotic therapy and changes in trends.
Stoll BJ. Pathogenesis and epidemiology of neonatal infection. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson Textbook of Pediatrics. 17th ed. London: WB Saunders; 2004. p. 623-400.
Palazzi DL, Klein JO, Baker CJ. Bacterial sepsis and meningitis. In: Remington JS, Klein JO, editors. Infectious Disease of the Fetus and Newborn. 6th ed. Philadelphia: WB Saunders; 2006. p. 248-83.
Edwards MS. Postnatal bacterial infections. In: Martin RJ, Fanaroff AA, Walsh MC, editors. Fanaroff and Martin's Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 8th ed. Philadelphia, Pa: Mosby; 2006. p. 791-825.
Cloherty JP, Eichenwald EC, Strark AR, editors. Manual of Neonatal Care. 5th ed. Philadelphia: Lippincott Williams & Wilkins 2004; p. 287-311.
Cordero L, Sananes M, Ayers LW. Bloodstream infections in a neonatal intensive-care unit: 12 years' experience with an antibiotic control program. Infect Control Hosp Epidemiol 1999;20(4):242-6.
Sidebottom DG, Freeman J, Platt R, Epstein MF, Goldmann DA. Fifteen-year experience with bloodstream isolates of coagulase-negative staphylococci in neonatal intensive care. J Clin Microbiol 1988;26(4):713-8.
Baumgart S, Hall SE, Campos JM, Polin RA. Sepsis with coagulase-negative staphylococci in critically ill newborns. Am J Dis Child 1983;137(5):461-3.
Cainen G, Campognone P, Peter G. Coagulase-negative staphylococcal bacteremia in newborns. Clin Pediatr 1984;23:542-4.
Donowitz LG, Haley CE, Gregory WW, Wenzel RP.Neonatal intensive care unit bacteremia: emergence of gram-positive bacteria as major pathogens. Am J Infect Control 1987;15(4):141-7.
Freeman J, Platt R, Sidebottom DG, Leclair JM, Epstein MF, Goldmann DA. Coagulase-negative staphylococcal bacteremia in the changing neonatal intensive care unit population. Is there an epidemic? JAMA 1987;258(18):2548-52.
Park CH, Seo JH, Lim JY, Woo HO, Youn HS. Changing trend of neonatal infection: experience at a newly established regional medical center in Korea. Pediatr Int 2007;49(1):24-30.
Movahedian A, Moniri R, Mosayebi Z. Bacterial culture of neonatal sepsis. Iranian J Publ Health 2006;35(4):84-9. [Persian]
Samaee H. Assessing the etiology and sensitivity of causative organisms initiating bacterial sepsis in the newborn. J Med Council of Islamic Republic of Iran 1998;15:151-4. [Persian]
Masheof Rasoul U. Bacteriology of neonatal septicemia and antibiotic susceptibility in Hamadan hospital. J Hamadan Uni Med Sci 1999;2:136-43. [Persian]
Yalaz M, Cetin H, Akisu M, Aydemir S, Tunger A, Kültürsay N. Neonatal nosocomial sepsis in a level-III NICU: evaluation of the causative agents and antimicrobial susceptibilities. Turk J Pediatr 2006;48(1):13-8.
Makhoul IR, Sujov P, Smolkin T, Lusky A, Reichman B; Israel Neonatal Network. Pathogen-specific early mortality in very low birth weight infants with late-onset sepsis: a national survey. Clin Infect Dis 2005;40(2):218-24.
Makhoul IR, Kassis I, Smolkin T, Tamir A, Sujov P. Review of 49 neonates with acquired fungal sepsis: further characterization. Pediatrics 2001;107(1):61-6.
Flidel-Rimon O, Friedman S, Gradstein S, Bardenstein R, Shinwell ES. Reduction in multiresistant nosocomial infections in neonates following substitution of ceftazidime with piperacillin/tazobactam in empiric antibiotic therapy. Acta Paediatr 2003;92(10):1205-7.