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Empiric Antibiotic Use and Susceptibility in Infants With Bacterial Infections: A Multicenter Retrospective Cohort
Elana A Feldman1, Russell J McCulloh2, Angela L Myers2
1University of Washington School of Medicine, Seattle, Washington; elana.a.feldman@gmail.com.
Insights
Hospital antibiotic use varied for infant infections, but susceptibility patterns were similar. Adding ampicillin to cephalosporins minimally improved coverage for urinary tract infections (UTI), bacteremia, or meningitis in young infants.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Neonatal Bacterial Infections
Background:
- Young infants (<90 days) with bacterial infections like urinary tract infection (UTI), bacteremia, or meningitis require prompt empirical antibiotic treatment.
- Significant variations in empirical antibiotic prescribing practices exist across different healthcare institutions.
- Understanding hospital-level differences in bacterial epidemiology and antimicrobial susceptibility is crucial for optimizing treatment guidelines.
Purpose of the Study:
- To compare hospital variations in empirical antibiotic prescribing for common bacterial infections in young infants.
- To analyze differences in bacterial pathogens and their antimicrobial susceptibility patterns across pediatric hospitals.
- To evaluate the effectiveness of common empirical antibiotic regimens in treating infections in infants <90 days old.
Main Methods:
- Retrospective review of medical records for infants <90 days old with UTI, bacteremia, or meningitis across 8 US children's hospitals.
- Utilized the Pediatric Health Information System database for case identification and antibiotic use data.
- Assessed infection types, causative pathogens, and antimicrobial susceptibility through medical record review.
Main Results:
- Identified 470 infants with bacterial infections; 77% had UTI, and 23% had meningitis or bacteremia. Infection types did not significantly differ between hospitals.
- Significant hospital-level variations were observed in empirical antibiotic use (P < .01).
- Antimicrobial susceptibility patterns for common empirical regimens were similar across hospitals; third-generation cephalosporins provided adequate empirical coverage for most cases.
Conclusions:
- Empirical antibiotic use for bacterial infections in young infants varied significantly among diverse US children's hospitals.
- Antimicrobial susceptibility to common regimens was consistent across hospitals, suggesting similar underlying pathogen resistance.
- Findings support the development of national guidelines for empirical antibiotic use in infants with suspected bacterial infections.
Objectives:
To assess hospital differences in empirical antibiotic use, bacterial epidemiology, and antimicrobial susceptibility for common antibiotic regimens among young infants with urinary tract infection (UTI), bacteremia, or bacterial meningitis.
Methods:
We reviewed medical records from infants <90 days old presenting to 8 US children's hospitals with UTI, bacteremia, or meningitis. We used the Pediatric Health Information System database to identify cases and empirical antibiotic use and medical record review to determine infection, pathogen, and antimicrobial susceptibility patterns. We compared hospital-level differences in antimicrobial use, pathogen, infection site, and antimicrobial susceptibility.
Results:
We identified 470 infants with bacterial infections: 362 (77%) with UTI alone and 108 (23%) with meningitis or bacteremia. Infection type did not differ across hospitals (P = .85). Empirical antibiotic use varied across hospitals (P < .01), although antimicrobial susceptibility patterns for common empirical regimens were similar. A third-generation cephalosporin would have empirically treated 90% of all ages, 89% in 7- to 28-day-olds, and 91% in 29- to 89-day-olds. The addition of ampicillin would have improved coverage in only 4 cases of bacteremia and meningitis. Ampicillin plus gentamicin would have treated 95%, 89%, and 97% in these age groups, respectively.
Conclusions:
Empirical antibiotic use differed across regionally diverse US children's hospitals in infants <90 days old with UTI, bacteremia, or meningitis. Antimicrobial susceptibility to common antibiotic regimens was similar across hospitals, and adding ampicillin to a third-generation cephalosporin minimally improves coverage. Our findings support incorporating empirical antibiotic recommendations into national guidelines for infants with suspected bacterial infection.
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