Neonatal Escherichia coli infections: concerns regarding resistance to current therapy

Friedman, Smadar; Shah, Vibhuti; Ohlsson, Arne; Ag, Matlow

doi:10.1111/j.1651-2227.2000.tb00365.x

Cited by 41 publications

(26 citation statements)

References 5 publications

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“…However, differences in the percentages of Gram-resistant isolates from 3% [3] to 50% [5,24] among EONS strains and from 0% [19] to 16% [4] among LONS strains seem to be present among the different studies [3,5,17,24]. Quinolone resistance is frequently associated with extended-spectrum cephalosporin resistance in Enterobacteriaceae [25]; however, this association was not found in the present study.…”

Section: Discussioncontrasting

confidence: 54%

“…However, there are also several studies that have demonstrated that this relationship does not exist [20]. Friedman et al [5] postulated that the presence of prolonged rupture of the fetal membranes and an elevated maternal temperature during labor, which is suggestive of chorioamnionitis, are also perinatal variables associated with the emergence of resistant E. coli isolates. In addition, a lower gestational age and birth weight are neonatal variables associated with the appearance of these resistant strains.…”

Section: Discussionmentioning

confidence: 99%

“…Stoll et al [3] studied early onset neonatal sepsis from 1998 to 2000 and found a reduction in group B streptococcal sepsis (from 5.9 to 1.7 per 1,000 live births of very low-weight infants, p < 0.001) and an increase in E. coli (from 3.2 to 6.8 per 1,000 live births, p = 0.004). The use of maternal intrapartum antibiotics for the prevention of GBS infection in the neonate is becoming increasingly common in developed countries [5], but most of these antibiotics are administered in a term pregnancy. Maternal prophylactic antibiotics are also used in cases of preterm premature rupture of membranes and if chorioamnionitis is suspected [6].…”

Section: Introductionmentioning

confidence: 99%

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Antimicrobial Resistance of Escherichia coli Strains Causing Neonatal Sepsis between 1998 and 2008

et al. 2012

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Background: Bloodstream infections are a significant cause of neonatal morbidity and death. An increase in the incidence of early neonatal sepsis due to Escherichia coli has been reported. The objective was to evaluate the antimicrobial resistance of E. coli strains causing early-onset neonatal sepsis (EONS) and late-onset neonatal sepsis (LONS) and their evolution. Methods:E. coli strains from EONS and hospital-acquired LONS collected at the Hospital Clinic of Barcelona were included in the study. Results: No statistically significant differences in resistance profiles were found between strains causing EONS and LONS. An increase in the resistance to all the antimicrobial agents studied was observed for the period 2000–2008 in comparison with the 1985–1999 period, with the increase in resistance to gentamicin, piperacillin and tobramycin being statistically significant. Two strains carried the bla_CTX-M genes (bla_CTX-M-14 and bla_CTX-M-15). Conclusion: The increase in ampicillin and gentamicin resistance makes a change in the treatment of neonates necessary.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Antimicrobial Resistance of Escherichia coli Strains Causing Neonatal Sepsis between 1998 and 2008

et al. 2012

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“…At the same time, some concern arose from the concomitant emergence of neonatal infections with ampicillin-resistant Escherichia coli [12]. This adverse effect of any widespread antibiotic therapy was dreaded from the outset of the prophylaxis policies [1,2] and has indeed been observed by several authors in the past decade [13][14][15][16][17][18][19]. Awareness of all changes in local bacterial epidemiology is of uppermost importance to any neonatal care center in order to adapt the presumptive antibiotic therapy used in the case of suspected neonatal sepsis.…”

Section: Introductionmentioning

confidence: 99%

Effects of Antenatal Antibiotics on the Incidence and Bacteriological Profile of Early-Onset Neonatal Sepsis

Laugel¹,

Kuhn²,

Beladdale³

et al. 2003

Neonatology

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Background: Recommendations for the use of antenatal antibiotics have been widely implemented in the past few years, notably to prevent group B streptococcal disease or to prolong pregnancy in the case of preterm premature rupture of the membranes. Objectives: We designed a retrospective study to assess the potential effects of this increasing use of antibiotics on the incidence and bacteriological profile of early-onset neonatal sepsis (EONS). Methods: All neonates referred to our department for suspected EONS from January 1 1995 through December 31 1999 were included. Antenatal antibiotic exposure together with clinical and microbiological data from the neonatal period were gathered and analyzed on a yearly basis. Results: Of the 485 newborns who met the inclusion criteria, there were 101 cases of culture-confirmed sepsis; 339 cases of suspected sepsis and 69 cases of confirmed sepsis involved children born in the hospital, among a total of 16,627 live births registered in our center over the study period. The overall incidence of EONS dropped from 6.8 to 0.6/1,000 births between 1995 and 1999 (p < 0.001), but the rate of group B streptococcal infection decreased much more rapidly than that of non-group B streptococcal infection. We observed a trend towards the emergence of ampicillin-resistant Escherichia coli strains, which were isolated in seven cases. Among E. coli infections, ampicillin resistance was statistically linked with antenatal antibiotic use (p = 0.025). We also delineated several risk factors associated with these infections. Conclusion: In our center, antenatal antibiotic treatment was effective in reducing the incidence of EONS, but this benefit may come at the cost of favoring the emergence of ampicillin-resistant organisms causing severe neonatal infections. Antenatal and postnatal antibiotic treatment strategies should take this adverse effect into account.

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“…5 However, there has been an increase in resistance of Escherichia coli to gentamicin and tobramycin. 6,7 In 2011, our institution-specific susceptibilities to gentamicin and tobramycin were 90% and 91%, respectively. Because of decreased susceptibility rates with gentamicin and tobramycin, prescribers have opted to change the aminoglycoside of choice for neonatal sepsis to amikacin, with an E coli 99% susceptibility rate in our NICU.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Amikacin Pharmacokinetics in Neonates Following Implementation of a New Dosage Protocol

Hughes¹,

Johnson²,

Anderson³

et al. 2017

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVESThe primary aim was to compare attainment of goal serum amikacin concentrations using two dosage regimens in patients admitted to a neonatal intensive care unit. Secondary objectives included comparison of percentages of supratherapeutic trough concentrations, and subtherapeutic and supratherapeutic peak concentrations. METHODSThis was an Institutional Review Board-approved, retrospective study of neonates receiving amikacin during January-December 2013 (group 1) and January-December 2014 (group 2). Group 1 received amikacin dosage consistent with published recommendations, whereas group 2 was dosed using a modified protocol that was based on postmenstrual and postnatal age. Goal serum amikacin peak concentration was defined as 20 to 35 mg/L; hence, subtherapeutic and supratherapeutic peak concentrations were defined as <20 mg/L and >35 mg/L, respectively. Supratherapeutic trough concentrations were >8 mg/L. Between-group analysis was performed using Wilcoxon-Mann-Whitney test, Student t-test or χ 2 , or Fisher exact analysis as appropriate with a p value <0.05. RESULTSA total of 278 neonates were included (group 1: n = 144; group 2: n = 134). Most patients were male (60%) and were admitted for prematurity or respiratory distress (77%). The median gestational age in group 1 was 34.4 weeks (range, 30.0-37.9 weeks) versus group 2 at 36.9 weeks (range, 31.4-38.9 weeks), whereas the postnatal age was similar between both groups at 4 days. There was a significant increase in attaining goal peak amikacin concentrations between groups 1 and 2, 34% versus 84%, p < 0.001, and decrease in supratherapeutic peak concentrations, 65% versus 12%, p < 0.001. There was no significant difference in subtherapeutic peak or supratherapeutic trough concentrations.CONCLUSIONS A modified neonatal amikacin dosage protocol resulted in increased peak amikacin serum concentration compared with published dosage recommendations. Future research should focus on determination of the optimal dosage regimen in neonates.

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Neonatal Escherichia coli infections: concerns regarding resistance to current therapy

Abstract: Ampicillin and gentamicin resistance is emerging in neonatal E. coli isolates from invasive infection. Current- empiric management of neonatal sepsis requires re-evaluation given changing antimicrobial susceptibilities.

Cited by 41 publications

References 5 publications

Antimicrobial Resistance of <b><i>Escherichia coli</i></b> Strains Causing Neonatal Sepsis between 1998 and 2008

Antimicrobial Resistance of <b><i>Escherichia coli</i></b> Strains Causing Neonatal Sepsis between 1998 and 2008

Effects of Antenatal Antibiotics on the Incidence and Bacteriological Profile of Early-Onset Neonatal Sepsis

Comparison of Amikacin Pharmacokinetics in Neonates Following Implementation of a New Dosage Protocol

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