Next Article in Journal
Acinetobacter baumannii Resistance: A Real Challenge for Clinicians
Previous Article in Journal
Antibiotics and Environment
Article

Risk Factors of Initial Inappropriate Antibiotic Therapy and the Impacts on Outcomes of Neonates with Gram-Negative Bacteremia

1
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
2
Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi 613, Taiwan
3
Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin 638, Taiwan
4
College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
5
Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Yunlin Chang Gung Memorial Hospital, 707, Gongye Rd, Sansheng, Mailiao Township, Yunlin 638, Taiwan
*
Author to whom correspondence should be addressed.
Received: 8 March 2020 / Revised: 16 April 2020 / Accepted: 21 April 2020 / Published: 23 April 2020
(This article belongs to the Section Antibiotics Use and Antimicrobial Stewardship)
Background: Timely appropriate empirical antibiotic plays an important role in critically ill patients with gram-negative bacteremia. However, the relevant data and significant impacts have not been well studied in the neonatal intensive care unit (NICU). Methods: An 8-year (1 January 2007–31 December 2014) cohort study of all NICU patients with gram-negative bacteremia (GNB) in a tertiary-care medical center was performed. Inadequate empirical antibiotic therapy was defined when a patient did not receive any antimicrobial agent to which the causative microorganisms were susceptible within 24 h of blood culture sampling. Neonates with GNB treated with inadequate antibiotics were compared with those who received initial adequate antibiotics. Results: Among 376 episodes of Gram-negative bacteremia, 75 (19.9%) received inadequate empirical antibiotic therapy. The cause of inadequate treatment was mostly due to the pathogen resistance to prescribed antibiotics (88.0%). Bacteremia caused by Pseudomonas aeruginosa (Odds ratio [OR]: 20.8, P < 0.001) and extended spectrum β-lactamase (ESBL)-producing bacteria (OR: 18.4, P < 0.001) had the highest risk of inadequate treatment. Previous exposure with third generation cephalosporin was identified as the only independent risk factor (OR: 2.52, 95% CI: 1.18–5.37, P = 0.018). Empirically inadequately treated bacteremias were significantly more likely to have worse outcomes than those with adequate therapy, including a higher risk of major organ damage (20.0% versus 6.6%, P < 0.001) and infectious complications (25.3% versus 9.3%, P < 0.001), and overall mortality (22.7% versus 11.0%, P = 0.013). Conclusions: Inadequate empirical antibiotic therapy occurs in one-fifth of Gram-negative bacteremias in the NICU, and is associated with worse outcomes. Additional prospective studies are needed to elucidate the optimal timing and aggressive antibiotic regimen for neonates who are at risk of antibiotic-resistant Gram-negative bacteremia. View Full-Text
Keywords: mortality; antimicrobial therapy; septicemia; late-onset sepsis; antibiotic resistance mortality; antimicrobial therapy; septicemia; late-onset sepsis; antibiotic resistance
Show Figures

Figure 1

MDPI and ACS Style

Chu, S.-M.; Hsu, J.-F.; Lai, M.-Y.; Huang, H.-R.; Chiang, M.-C.; Fu, R.-H.; Tsai, M.-H. Risk Factors of Initial Inappropriate Antibiotic Therapy and the Impacts on Outcomes of Neonates with Gram-Negative Bacteremia. Antibiotics 2020, 9, 203. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9040203

AMA Style

Chu S-M, Hsu J-F, Lai M-Y, Huang H-R, Chiang M-C, Fu R-H, Tsai M-H. Risk Factors of Initial Inappropriate Antibiotic Therapy and the Impacts on Outcomes of Neonates with Gram-Negative Bacteremia. Antibiotics. 2020; 9(4):203. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9040203

Chicago/Turabian Style

Chu, Shih-Ming; Hsu, Jen-Fu; Lai, Mei-Yin; Huang, Hsuan-Rong; Chiang, Ming-Chou; Fu, Ren-Huei; Tsai, Ming-Horng. 2020. "Risk Factors of Initial Inappropriate Antibiotic Therapy and the Impacts on Outcomes of Neonates with Gram-Negative Bacteremia" Antibiotics 9, no. 4: 203. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9040203

Find Other Styles
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

1
Search more from Scilit
 
Search
Back to TopTop