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A Comparison of Sequelae After a Practice Change From Vancomycin to Ampicillin Containing Antibiotic Regimens for

James Hunter Fly1,2, Kelley R Lee1,2, Sandra R Arnold2,3

  • 1Department of Clinical Pharmacy and Translational Science, College of Pharmacy, The University of Tennessee Health Science Center, Memphis, TN, USA.

Clinical Pediatrics
|August 15, 2024
PubMed

Insights

Ampicillin is effective for treating necrotizing enterocolitis (NEC), even with high MRSA rates. This antibiotic change did not increase adverse outcomes like acute kidney injury (AKI) or NEC sequelae.

Area of Science:

  • Neonatal surgery
  • Pediatric infectious diseases
  • Clinical pharmacology

Background:

  • Necrotizing enterocolitis (NEC) is a serious condition in premature infants.
  • Antibiotic selection for NEC is critical, especially with rising antimicrobial resistance.
  • Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant challenge in neonatal intensive care units.

Purpose of the Study:

  • To evaluate the impact of switching from vancomycin to ampicillin for Gram-positive coverage in NEC management.
  • To compare the occurrence of NEC-related sequelae and acute kidney injury (AKI) between antibiotic regimens.
  • To identify risk factors for sequelae and AKI in NEC patients.

Main Methods:

  • Retrospective, single-center cohort analysis of 73 NEC patients (2016-2020).
  • Utilized multivariate logistic regression to analyze associations between antibiotic regimens, sequelae, and AKI.
  • Compared outcomes after institutional guideline change replacing vancomycin with ampicillin.

Main Results:

  • Ampicillin-containing regimens were not associated with increased NEC sequelae or AKI.
  • Lower postmenstrual age (<29 weeks) and vasopressor use were linked to sequelae.
  • Stage III NEC was independently associated with a higher risk of AKI.

Conclusions:

  • Ampicillin-containing regimens are effective and safe for NEC management, even in settings with high MRSA prevalence.
  • Early postmenstrual age and vasopressor support are risk factors for NEC sequelae.
  • Severe NEC (Stage III) is a significant predictor of AKI.
Keywords:
acute kidney injuryampicillinantimicrobial stewardshipnecrotizing enterocolitispreterm birthvancomycin

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