Ampicillin and Gentamicin Treatment for Early Onset Neonatal Sepsis: When One Size Does Not Fit All.

Autor:	Daniels K; University of California, Los Angeles, CA, USA., Arrieta A; Pediatric Infectious Diseases, CHOC Children's Hospital, Orange, CA, USA.; Department of Pediatrics, School of Medicine, University of California, Irvine, Irvine, CA, USA., Nieves DJ; Pediatric Infectious Diseases, CHOC Children's Hospital, Orange, CA, USA.; Department of Pediatrics, School of Medicine, University of California, Irvine, Irvine, CA, USA., Bhakta K; Department of Pediatrics, School of Medicine, University of California, Irvine, Irvine, CA, USA.; Neonatology, CHOC Children's Hospital, Orange, CA, USA., Tran MT; Pharmacy Services, CHOC Children's Hospital, Orange, CA, USA., Osborne S; CHOC Research Institute, CHOC Children's Hospital, Orange, CA, USA., Morphew T; CHOC Research Institute, CHOC Children's Hospital, Orange, CA, USA.
Jazyk:	angličtina
Zdroj:	Clinical pediatrics [Clin Pediatr (Phila)] 2023 Oct; Vol. 62 (9), pp. 1027-1031. Date of Electronic Publication: 2023 Jan 24.
DOI:	10.1177/00099228221150612
Abstrakt:	Based on in vitro susceptibilities and the concern for emergence of resistance and long-term safety, ampicillin plus gentamicin remains the recommended antibiotic regimen for early onset neonatal sepsis. Our objective was to identify potential limitations of this regimen based on clinical and pathogen characteristics while minimizing risks associated with prolonged antibiotic exposure. We identified 43 gram-negative pathogens in 42 patients. Escherichia coli ( E coli ) occurred in 50% and Streptococcus agalactiae in 23.8% of patient. Ampicillin resistance was common, particularly in E coli (85.7%). Mortality was 23.8%, all due to E coli . We found that E coli is the most frequent pathogen and has a high mortality particularly in neonates < 1500 g; mortality is high with the current dosing strategy when E coli is resistant to ampicillin even when sensitive to gentamicin; resistance to gentamicin remains low but seems to be increasing while resistance to third-generation cephalosporins remains very low.
Databáze:	MEDLINE
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