Empirical treatment of neonatal sepsis: are the current guidelines adequate?

  • Muller-Pebody B
  • Johnson A
  • Heath P
 et al. 
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Abstract

Objectives To use national laboratory surveillance data to determine
whether pathogens responsible for neonatal bacteraemia were sensitive to
nationally recommended antibiotic regimens.
Design All reports of neonatal bacteraemia received by the Health
Protection Agency's voluntary surveillance scheme in England and Wales
from January 2006 until March 2008, were extracted from the database.
Organisms were ranked by frequency, and proportions susceptible to
antimicrobials recommended for empirical treatment of neonatal sepsis
were determined.
Results There were 1516 reports of bacteraemia for neonates (early-onset) and 3482 reports for neonates 2-28 days old (late-onset).
For early-onset bacteraemia, group B streptococcus (GBS) was the most
frequent pathogen (31%) followed by coagulase-negative staphylococci
(CoNS; 22%), non-pyogenic streptococci (9%) and Escherichia coli
(9%). For late-onset bacteraemia, CoNS were isolated most frequently
(45%), followed by Staphylococcus aureus (13%), Enterobacteriaceae
(9%), E coli (7%) and GBS (7%). More than 94% of organisms
(early-onset) were susceptible to regimens involving combinations of
penicillin with either gentamicin or amoxicillin, amoxicillin combined
with cefotaxime or cefotaxime monotherapy. More than 95% of organisms
(late-onset) were susceptible to gentamicin with either flucloxacillin
or amoxicillin and amoxicillin with cefotaxime, but only 79% were
susceptible to cefotaxime monotherapy.
Conclusions Current guidelines for empirical therapy in neonates with
sepsis are appropriate. However, gentamicin-based regimens should be
used in preference to cefotaxime-based treatments, because of lower
levels of susceptibility to cefotaxime and the need to avoid exerting
selective pressure for resistance. Surveillance data linked to clinical
data should further inform rational antibiotic prescribing in neonatal
units.

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Authors

  • B Muller-Pebody

  • A P Johnson

  • P T Heath

  • R E Gilbert

  • K L Henderson

  • M Sharland

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