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Ecological impact of ampicillin and cefuroxime in neonatal units
1Department of Paediatrics, Danderyd Hospital, Sweden.
Insights
Antibiotic use in neonatal units drives resistance in E. coli and Klebsiella. Ampicillin-based treatments pose a higher risk for drug-resistant strains in newborns compared to cefuroxime.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Microbiology
Background:
- Antibiotic resistance is a growing global health concern, particularly in vulnerable neonatal populations.
- Understanding the link between local antibiotic consumption and the emergence of resistant bacteria is crucial for infection control.
Purpose of the Study:
- To investigate the association between antibiotic consumption and fecal carriage of beta-lactam-resistant Escherichia coli and Klebsiella spp. in neonatal units.
- To determine the impact of specific antibiotic classes on the development of antibiotic resistance in neonates.
Main Methods:
- A study involving 953 children discharged from twenty-two neonatal units.
- Analysis of the correlation between local antibiotic usage patterns and the prevalence of resistant bacterial strains.
Main Results:
- Increased carriage of ampicillin-resistant E. coli and ampicillin-, cefuroxime-, and cephalexin-resistant Klebsiella spp. was associated with ampicillin use.
- Inverse relationship observed between ampicillin and cephalosporin (primarily cefuroxime) consumption.
- Cephalosporin use showed a negative correlation with resistance to ampicillin, cefuroxime, and cephalexin in Klebsiella spp.
Conclusions:
- Antibiotic resistance risk is influenced by related antibiotic agents, not solely the drug used.
- Antibiotics have an indirect impact on the microflora of untreated patients.
- Ampicillin-based regimens are more likely to induce drug resistance in newborns than cefuroxime.
Abstract:
The relation between local antibiotic consumption and faecal carriage of beta-lactam-resistant strains of Escherichia coli and Klebsiella spp was studied in 953 children discharged from twenty-two neonatal units. An increased rate of carriers of Klebsiella spp strains resistant to ampicillin, cefuroxime, and cephalexin and of E coli strains resistant to ampicillin was associated with the use of ampicillin, with or without gentamicin. Ampicillin and cephalosporin (86% cefuroxime) consumptions were inversely related, which probably explained the paradox that cephalosporin use (and therefore less ampicillin use) was negatively correlated with the carriage of Klebsiella spp strains resistant to ampicillin, cefuroxime, and cephalexin. The ecological impact of antibiotics was much the same among treated and untreated babies in each unit. The findings show a greater risk of drug resistance due to a related agent rather than to the drug itself and a clear indirect impact of an antibotic on the microflora of untreated patients. Ampicillin-based regimens are more likely than cefuroxime to produce drug-resistant strains in the newborn.