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2015 ; 34
(9
): 933-6
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Neonatal Escherichia coli Bloodstream Infections: Clinical Outcomes and Impact of
Initial Antibiotic Therapy
#MMPMID26065862
Bergin SP
; Thaden JT
; Ericson JE
; Cross H
; Messina J
; Clark RH
; Fowler VG Jr
; Benjamin DK Jr
; Hornik CP
; Smith PB
Pediatr Infect Dis J
2015[Sep]; 34
(9
): 933-6
PMID26065862
show ga
BACKGROUND: Escherichia coli 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. METHODS: We
identified all infants with E. coli 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 E. coli 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. RESULTS: We identified 258 episodes of E. coli BSI,
including 123 (48%) ampicillin-resistant isolates. Unadjusted 30-day mortality
did not significantly differ between infants with ampicillin-resistant versus
ampicillin-susceptible E. coli BSI [11 of 123 (9%) vs. 7 of 135 (5%); P = 0.33;
adjusted odds ratio = 1.37 (95% confidence interval: 0.39, 4.77)]. Among
ampicillin-resistant E. coli BSIs, 30-day mortality was not significantly lower
for infants treated with at least one empiric antimicrobial active against
ampicillin-resistant E. coli versus infants receiving no active empiric agent
[adjusted odds ratio = 1.50 (0.07, 33.6)]. CONCLUSIONS: In this population of
infants with E. coli BSI, ampicillin resistance was not associated with
significantly increased mortality. Among the subset of infants with
ampicillin-resistant E. coli, appropriate empirical antibiotic therapy was not
associated with lower mortality.
|*Drug Resistance, Bacterial
[MESH]
|Anti-Bacterial Agents/pharmacology/*therapeutic use
[MESH]