Background and Objective: Fever in neonates is a possible sign of serious bacterial infection (SBI) necessitating admission, complete sepsis work-up and antimicrobials; these usually include ampicillin+gentamicin (A+G) or ampicillin+cefotaxime (A+C). Due to increasing resistance of Gram-negatives to antimicrobials we aimed to determine whether the current empiric treatments for SBI are still appropriate.
Methods: Data were collected retrospectively at Galilee Medical Center between 1/2007-6/2013 for all neonates ≤30 days-old, including afebrile infants, who had a complete sepsis work-up.
Results: Of 447 neonates, 157 (35%) had SBI and 39/157 (25%) were afebrile. Among SBI patients, males and urinary tract infections (UTI) predominated (72% and 91%, respectively); Meningitis occurred in 2 neonates (1%). Gram-negatives accounted for 87% of SBI: E.coli caused 70% of SBI. Among Gram-positives, E.faecalis was isolated in 9% and Group B Streptococcus (GBS) in 2% of SBI, all were ampicillin-susceptible. Listeria was not isolated. A+G were used empirically in 90% of SBI. Resistance to A+C, A+G, and A+C+G was noted in 16 (10%), 6 (4%), and 2 (1%) of SBI, respectively (A+G Vs. A+C, p=0.027). A+G-resistant SBI included UTI (n=5) and bacteremia (n=1); all were amikacin-susceptible and had a favorable prognosis. Prior exposure to antimicrobials and hospitalization in neonatal intensive care unit (NICU) were associated with gentamicin resistance (p<0.001). No significant changes occurred in rates of antibiotic resistance during the study.
Conclusions: A+G is appropriate for neonatal sepsis and is superior to A+C. Ampicillin is needed mainly for infections caused by Enterococcus and GBS. Amikacin, instead of gentamicin, should be considered in neonates evaluated for SBI who had a previous NICU admission or antimicrobial therapy. Continued surveillance for antimicrobial resistance is warranted.
