No Change in Antibiotic Susceptibility Patterns in the Neonatal ICU Over Two Decades

Abstract

Objectives: 

To identify trends in early-onset sepsis and late-onset sepsis neonatal rates and to evaluate the appropriateness of the empirical antibiotic protocols.

Design: 

A 17-yr (1993–2009) analysis of positive blood and cerebrospinal fluid cultures.

Setting: 

The two neonatal ICUs at the Hadassah- Hebrew University Medical Center.

Results: 

During this period, 991 infants had at least one episode of either bacteremia or meningitis. The overall incidence of early-onset sepsis was 0.64 per 1,000 live births with a nonsignificant trend over the study period (p = 0.37). The overall incidence of late-onset sepsis was 7.5 per 100 admissions with a significant positive trend in the incidence rates (p = 0.021). The incidence of late-onset sepsis was 7.5 per 100 admissions with a significant positive trend in the prevalence rates (p = 0.021). The prevalence of early-onset group B Streptococcus bacteremia decreased significantly throughout the study period. Among late-onset sepsis, Gram-positive and fungi infection rates were stable over time, while Gram-negative infection rates showed a significant positive trend (p = 0.007). No significant change in the susceptibility rate of the isolated Gram-negative bacteria in late-onset sepsis for the common antibacterial drugs was found. About 85% and 90% of the isolated organisms were susceptible to our early-onset sepsis (ampicillin and gentamicin) and late-onset sepsis (vancomycin and cefotaxime) protocols, respectively, and these rates were stable over the study period (p = .1 and .55, respectively). Sepsis-related mortality was higher among Gram- negative sepsis cases resistant to our empiric antibiotic protocol.

Conclusions: 

Our empiric antibiotic protocols are appropriate despite their continuous use over the last 17 yrs. This may have been achieved by the use of a controlled antibiotic program and infection control efforts.