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Use of Amikacin in a hospital for children: microbiological and clinical studies
Insights
Amikacin demonstrates high in vitro effectiveness against Gram-negative bacteria in neonatal nosocomial infections. Clinical use showed successful treatment outcomes, supporting its recommendation for neonatal sepsis.
Area of Science:
- Clinical Microbiology
- Pediatric Infectious Diseases
- Pharmacology
Background:
- Nosocomial infections in newborns pose significant therapeutic challenges.
- Aminoglycosides are frequently used for Gram-negative bacterial infections.
- Understanding antimicrobial susceptibility is crucial for effective treatment.
Purpose of the Study:
- To assess the susceptibility trends of clinical isolates from newborns to available aminoglycosides.
- To evaluate the clinical efficacy of amikacin in treating neonatal infections.
- To provide therapeutic recommendations for aminoglycoside use in pediatric patients.
Main Methods:
- In vitro susceptibility testing of 211 clinical isolates (including Pseudomonas aeruginosa, Escherichia coli, Klebsiella, Serratia) against amikacin, sisomicin, gentamicin, and tobramycin.
- Clinical data analysis of amikacin treatment outcomes in 15 newborns with septicemia.
- Determination of minimal inhibitory concentration (MIC) and serum concentration monitoring.
Main Results:
- Amikacin exhibited the highest in vitro activity, with 90% of isolates sensitive.
- Sensitivity rates for other aminoglycosides were: sisomicin (80.5%), tobramycin (70%), and gentamicin (66%).
- No cross-resistance was observed between amikacin and other tested aminoglycosides.
- Amikacin treatment was successful in 13 of 15 neonates; two deaths were due to underlying conditions.
Conclusions:
- Amikacin is the most effective aminoglycoside against common Gram-negative pathogens in this neonatal population.
- Amikacin demonstrated favorable clinical outcomes in neonatal septicemia.
- A recommended dosage of 12 mg/kg/day for amikacin in neonatal infections, with MIC and serum level monitoring, is suggested.
Abstract:
Trends in relative susceptibility of clinical isolates, mostly from newborns with nosocomial infections, to the aminoglycosides in use in a hospital for children are described and related to practical therapeutic aspects. Currently, amikacin is the most effective of the available antibiotics against many gram-negative bacterial species, and its administration appears to be as complicated as that of other aminoglycosides. With 5 mug/ml taken as the cut-off point for susceptibility in vitro, 90% of 211 clinical isolates (Pseudomonas aeruginosa, Escherichia coli, Klebsiella, Serratia, and other species) could be considered sensitive to amikacin; the respective figures for sensitivity to sisomicin, gentamicin, and tobramycin were 80.5%, 66%, and 70%. Cross-resistance of microorganisms to amikacin and gentamicin, sisomicin, or tobramycin has not been demonstrated. Treatment with amikacin was successful in 13 of 15 children (premature and normal newborns with primarily septicemia); death of two patients was attributable to the underlying disease. For neonatal infections we recommend 12 mg of amikacin/kg per day; determination of the minimal inhibitory concentration for the causative pathogen and monitoring of serum concentrations are desirable.