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[Current orientation of antibiotic treatment in neonatal bacterial infection]
1Hôpital Trousseau.
Insights
Neonatal bacterial infections, including severe sepsis, require prompt, bactericidal antibiotics. Third-generation cephalosporins are recommended over ampicillin due to rising E. coli resistance, especially in high-risk areas.
Area of Science:
- Neonatal infectious diseases
- Bacteriology
- Pharmacology
Context:
- Neonatal sepsis presents a significant mortality risk.
- Early and effective antibiotic selection is critical for neonates.
- Maternal infections can transmit to newborns, necessitating targeted treatment.
Purpose:
- To review current antibiotic strategies for neonatal bacterial infections.
- To highlight the inadequacy of ampicillin against resistant E. coli strains.
- To recommend appropriate antibiotic regimens for neonatal sepsis, considering local resistance patterns.
Summary:
- Neonatal bacterial infections, particularly severe sepsis, are associated with high mortality.
- Third-generation cephalosporins should replace ampicillin due to over 50% E. coli resistance.
- Multidrug-resistant hospital-acquired bacteria pose a threat in tropical areas.
- Recommended treatment involves third-generation cephalosporins combined with aminoglycosides.
- Antibiotic cost and biological suitability require reevaluation in high-risk neonatal settings.
Impact:
- Improved treatment protocols for neonatal sepsis.
- Reduced mortality rates from bacterial infections in newborns.
- Guidance for antibiotic stewardship in neonatal intensive care units.
- Informed decision-making for empirical antibiotic therapy in neonates.
Abstract:
The bacterial infection are responsive of severe sepsis and localizations in neonates, with a high mortality. The right choice of the first antibiotics is essential, and they must be well-fitted, early and bactericidal. The antibiotics of choice in the mother-linked infections are directed towards streptococcus group B and E. coli. Ampicillin must be replaced by a third generation cephalosporin because E. coli are resistant in more than 50% of cases. In tropical areas the first neonatal infections may be also the fact of multiresistant hospital acquired bacteria, which are transmitted during delivery by lack of hygiene. As in the nosocomial infections the causative pathogens are resistant Enterobacteriaceae, Pseudomonas and Staphylococcus. In all cases the neonatologist must use cephalosporin 3rd generation associated to aminoglycoside. The biological background and the cost of those antibiotics must be reevaluated in the high risk-areas (delivery rooms, nurseries, pediatrics departments).