Reduction in multiresistant nosocomial infections in neonates following substitution of ceftazidime with piperacillin/tazobactam in empiric antibiotic therapy

Abstract

Aim: To evaluate the effect of a change in antibiotic protocol on pathogens that cause neonatal sepsis. Methods: Suspected sepsis was treated with amikacin together with ceftazidime in 1995–1998 and piperacillin/tazobactam in 1999–2002. Results: The annual rate for Klebsiella sepsis fell from 2.5 to 0.45 cases per 1000 admission days (p= 0.0001) between the two periods studied. Conclusion: The change from ceftazidime to piperacillin/tazobactam is associated with a decrease in the incidence of Klebsiella sepsis.

Impact of Empiric Antibiotic Use on Development of Infections caused by Extended-Spectrum β-Lactamase Bacteria in a Neonatal Intensive Care Unit

“…One previous study reported a similar temporal relationship between third-generation cephalosporin restriction and a decline in infections caused by ceftazidimeresistant or ESBL-producing Klebsiella in hospitalized neonates. 8 That study did not evaluate other risk factors that may have contributed to the development of resistant infections.…”

Values of C‐reactive protein, procalcitonin, and Staphylococcus‐specific PCR in neonatal late‐onset sepsis

“…Empiric AMT at the onset of neonatal LOS appears to be justified, when one considers the high early mortality rates from Gram‐negative LOS [1, 2, 26], the possibility of systemic spread and high mortality after fungal LOS [1, 2], and the significant morbidity caused by CoNS sepsis [27]. Empiric AMT has caused a decline of the incidence of multi‐resistant Klebsiella sepsis [28], and of the mortality from fungal sepsis through empiric use of amphotericin B [17]. We are aware that empiric administration of antifungal agents is still controversial among neonatologists.…”

Improving antibiotic prescribing in neonatal units: time to act: Table 1

“…As with EOS, in situations where clinical improvement is not evident or deterioration is occurring, an empiric change from flucloxacillin to vancomycin or teicoplanin should be considered, together with switching gentamicin for another antibiotic with broader activity against Gram-negative bacteria, for example, piperacillin/tazobactam (tazocin). The use of piperacillin/tazobactam rather than ceftazidime has been associated with a reduction in neonatal Klebsiella infections 31. A combination of vancomycin and gentamicin also provides good Gram-negative and Gram-positive cover but potentially has additive toxicity; this combination should therefore be used with caution.…”