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Published on: May 5, 2014
Broad spectrum antibiotics in newborns increase multi-drug resistant infections
Almudena Alonso-Ojembarrena1, José Vicente Martínez-Díaz2, Alfonso María Lechuga-Sancho1,3
1a Neonatal Intensive Care Unit . Puerta del Mar University Hospital , Cádiz . Spain.
Abstract:
Our objective was to determine if broad spectrum antibiotics (BSA) are associated with multi-resistant bacterial (MRB) infections in neonatal patients. We conducted a case-control study with two groups of patients: those with and without a MRB infection. We included 43 cases and 43 controls. MRB strains were: 21 S. maltophila (49%), 11 ESBL-producing Enterobacteriae (25%), 8 P. aeruginosa (19%) and 3 MRSA (7%). Odds ratio (OR) for MRB after seven days of carbapenems was 4.25 (95% confidence interval (CI) 1.4-17.4) and OR for MRB after seven days of third generation cephalosporin was 8 (95% CI 1.1-34.9). BSA longer than seven days, increases MRB infections 22.5 times in patients with bronchopulmonary dysplasia (BPD). Our data show a clear association between the use of BSA and the development of MRB infections, especially in BPD. Although we cannot state this is a causal relationship, we can recommend avoiding prolonged treatment with these antibiotics in preterm babies at risk of BPD.
Insights
Broad spectrum antibiotics are linked to multi-resistant bacterial infections in newborns. Prolonged use, especially in infants with bronchopulmonary dysplasia, significantly increases infection risk, suggesting cautious antibiotic stewardship.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Neonatal intensive care units (NICUs) face challenges with multi-resistant bacterial (MRB) infections.
- Broad spectrum antibiotics (BSA) are crucial but their prolonged use may contribute to resistance.
- Understanding the association between BSA and MRB in neonates is vital for infection control.
Purpose of the Study:
- To investigate the association between broad spectrum antibiotic (BSA) use and multi-resistant bacterial (MRB) infections in neonatal patients.
- To identify specific antibiotic classes and durations associated with increased MRB risk.
- To assess the impact of BSA on MRB development in neonates with bronchopulmonary dysplasia (BPD).
Main Methods:
- A case-control study design was employed, comparing neonatal patients with MRB infections (cases) to those without (controls).
- Data were collected on antibiotic exposure, focusing on BSA use and duration.
- Statistical analysis included calculating odds ratios (OR) with 95% confidence intervals (CI) to determine the association between BSA and MRB.
Main Results:
- MRB strains identified included Stenotrophomonas maltophilia, ESBL-producing Enterobacteriaceae, Pseudomonas aeruginosa, and MRSA.
- Prolonged use of carbapenems (>7 days) showed an OR of 4.25 for MRB, while third-generation cephalosporins (>7 days) had an OR of 8.
- BSA use exceeding seven days was associated with a 22.5-fold increase in MRB infections among neonates with bronchopulmonary dysplasia (BPD).
Conclusions:
- A significant association exists between broad spectrum antibiotic use and the development of multi-resistant bacterial infections in neonatal patients.
- The risk is particularly elevated with prolonged BSA treatment (>7 days), especially in preterm infants with BPD.
- Recommendations include judicious use and avoidance of prolonged BSA therapy in high-risk neonates to mitigate MRB development.
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