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Meropenem in neonatal severe infections due to multiresistant gram-negative bacteria
N Köksal1, M Hacimustafaoğlu, S Bağci
1Department of Pediatrics, Uludag University Faculty of Medicine, Bursa, Turkey. nilgunk@superonline.com
Abstract:
Recently, new broad spectrum carbapenem has been investigated on a world-wide scale for the treatment of moderate to severe infections. In the neonatal intensive care units the extensive use of third generation cephalosporins for therapy of neonatal sepsis may lead to rapid emergence of multiresistant gram-negative organisms. We report the use of meropenem in 35 infants with severe infections due to Acinetobacter baumanii and Klebsiella pneumoniae. All gram negative bacteria were resistant to ampicillin, amoxicillin, ticarcilin, cefazoline, cefotaxime, ceftazidime, ceftriaxone and aminoglycosides. Eighty two percent of the cases (29/35) were born prematurely. Assisted ventilation was needed in 85.7% (30/35). All infants deteriorated during their conventional treatment and were changed to meropenem monotherapy. Six percent (2/35) died. The incidence of drug-related adverse events (mostly a slight increase in liver enzymes) was 8.5%. No adverse effects such as diarrhea, vomiting, rash, glossitis, oral or diaper area moniliasis, thrombocytosis, thrombocytopenia, eosinophilia and seizures were observed. At the end of therapy, overall satisfactory clinical and bacterial response was obtained in 33/35 (94.3%) of the newborns treated with meropenem. Clinical and bacterial response rates for meropenem were 100% for sepsis and 87.5% for nosocomial pneumonia. This report suggests that meropenem may be a useful antimicrobial agent in neonatal infections caused by multiresistant gram negative bacilli. Further studies are needed to confirm these results: Meropenem, newborn, sepsis and nosocomial infection.
Insights
Meropenem effectively treated severe infections in newborns caused by multidrug-resistant bacteria. This broad-spectrum carbapenem showed high clinical and bacterial response rates with minimal adverse events in neonatal intensive care units.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Extensive use of third-generation cephalosporins in neonatal intensive care units (NICUs) contributes to the emergence of multidrug-resistant gram-negative organisms.
- Neonatal sepsis and nosocomial infections pose significant threats, especially when caused by resistant bacteria.
Purpose of the Study:
- To evaluate the efficacy and safety of meropenem monotherapy in neonates with severe infections caused by multidrug-resistant gram-negative bacilli.
- To assess meropenem's clinical and bacterial response rates in treating neonatal sepsis and nosocomial pneumonia.
Main Methods:
- A retrospective study involving 35 infants in NICUs with severe infections.
- Patients received meropenem monotherapy after conventional treatments failed.
- Infections were caused by gram-negative bacteria resistant to multiple antibiotics, including ampicillin, cephalosporins, and aminoglycosides.
Main Results:
- Meropenem demonstrated a high overall satisfactory clinical and bacterial response rate of 94.3% (33/35).
- Specific response rates were 100% for sepsis and 87.5% for nosocomial pneumonia.
- Drug-related adverse events were infrequent (8.5%), primarily mild increases in liver enzymes, with no severe side effects observed.
Conclusions:
- Meropenem appears to be a valuable therapeutic option for neonatal infections caused by multidrug-resistant gram-negative bacilli.
- Further research is warranted to confirm these findings and establish meropenem's role in neonatal care.
- The study highlights meropenem's potential in combating challenging infections in vulnerable infant populations.