Document Detail


Empirical treatment of neonatal sepsis: are the current guidelines adequate?
MedLine Citation:
PMID:  20584804     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To use national laboratory surveillance data to determine whether pathogens responsible for neonatal bacteraemia were sensitive to nationally recommended antibiotic regimens.
DESIGN: All reports of neonatal bacteraemia received by the Health Protection Agency's voluntary surveillance scheme in England and Wales from January 2006 until March 2008, were extracted from the database. Organisms were ranked by frequency, and proportions susceptible to antimicrobials recommended for empirical treatment of neonatal sepsis were determined.
RESULTS: There were 1516 reports of bacteraemia for neonates <48 h old (early-onset) and 3482 reports for neonates 2-28 days old (late-onset). For early-onset bacteraemia, group B streptococcus (GBS) was the most frequent pathogen (31%) followed by coagulase-negative staphylococci (CoNS; 22%), non-pyogenic streptococci (9%) and Escherichia coli (9%). For late-onset bacteraemia, CoNS were isolated most frequently (45%), followed by Staphylococcus aureus (13%), Enterobacteriaceae (9%), E coli (7%) and GBS (7%). More than 94% of organisms (early-onset) were susceptible to regimens involving combinations of penicillin with either gentamicin or amoxicillin, amoxicillin combined with cefotaxime or cefotaxime monotherapy. More than 95% of organisms (late-onset) were susceptible to gentamicin with either flucloxacillin or amoxicillin and amoxicillin with cefotaxime, but only 79% were susceptible to cefotaxime monotherapy.
CONCLUSIONS: Current guidelines for empirical therapy in neonates with sepsis are appropriate. However, gentamicin-based regimens should be used in preference to cefotaxime-based treatments, because of lower levels of susceptibility to cefotaxime and the need to avoid exerting selective pressure for resistance. Surveillance data linked to clinical data should further inform rational antibiotic prescribing in neonatal units.
Authors:
B Muller-Pebody; A P Johnson; P T Heath; R E Gilbert; K L Henderson; M Sharland;
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Publication Detail:
Type:  Journal Article     Date:  2010-06-28
Journal Detail:
Title:  Archives of disease in childhood. Fetal and neonatal edition     Volume:  96     ISSN:  1468-2052     ISO Abbreviation:  Arch. Dis. Child. Fetal Neonatal Ed.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-23     Completed Date:  2011-01-25     Revised Date:  2012-01-24    
Medline Journal Info:
Nlm Unique ID:  9501297     Medline TA:  Arch Dis Child Fetal Neonatal Ed     Country:  England    
Other Details:
Languages:  eng     Pagination:  F4-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Healthcare-Associated Infection and Antimicrobial Resistance, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London, UK. Berit.Muller-Pebody@hpa.org
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MeSH Terms
Descriptor/Qualifier:
Age of Onset
Anti-Bacterial Agents / therapeutic use*
Bacteremia / drug therapy*,  epidemiology,  microbiology
Bacteria / drug effects,  isolation & purification
England / epidemiology
Female
Humans
Infant, Newborn
Male
Microbial Sensitivity Tests
Population Surveillance
Practice Guidelines as Topic / standards
Wales / epidemiology
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents
Investigator
Investigator/Affiliation:
Ian Wong / ; Sonia Saxena / ; Paul Long / ; Alessandro Porta / ; Helen Bird / ; Ruthie Birger / ; Saida Mehonic / ; Shama Wagle / ; Joanna Murray / ; Elizabeth Koshy / ; Yingfen Hsia /
Comments/Corrections
Comment In:
Arch Dis Child Fetal Neonatal Ed. 2012 Jan;97(1):F75   [PMID:  21849304 ]
Arch Dis Child Fetal Neonatal Ed. 2011 Jan;96(1):F2-3   [PMID:  20547581 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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