Ampicillin Use in Infant Fever

Brown, Julie C.; Burns, Jane L.; Cummings, Peter

doi:10.1001/archpedi.156.1.27

Cited by 22 publications

(10 citation statements)

References 103 publications

(59 reference statements)

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“…We observed that overall resource utilization, antimicrobial use, and hospitalization rates varied across hospitals, but little variation was observed in revisit outcomes. Ampicillin has traditionally been administered to neonates suspected of having Listeria monocytogenes, an uncommon cause of bacteremia and meningitis in the febrile young infant, [34][35][36][37] especially beyond the first month of life, 38 and Enterococcus, similarly an uncommon cause of SBI. 34,37,38 Additionally, the prevalence of ampicillin resistance has been reported to be 36% to 53% in pathogens that cause SBI in the febrile young infant.…”

Section: Discussionmentioning

confidence: 99%

“…Ampicillin has traditionally been administered to neonates suspected of having Listeria monocytogenes, an uncommon cause of bacteremia and meningitis in the febrile young infant, [34][35][36][37] especially beyond the first month of life, 38 and Enterococcus, similarly an uncommon cause of SBI. 34,37,38 Additionally, the prevalence of ampicillin resistance has been reported to be 36% to 53% in pathogens that cause SBI in the febrile young infant. 34,39 Despite these findings, nearly two-thirds of hospitalized febrile infants in our study received ampicillin in combination with gentamicin or a third-generation cephalosporin, with significant interhospital variation.…”

Section: Discussionmentioning

confidence: 99%

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Variation in Care of the Febrile Young Infant <90 Days in US Pediatric Emergency Departments

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Various low-risk criteria have been developed to guide management of the febrile young infant (,90 days), but they differ in age criteria, recommendations, and implementation. Therefore, variation in care is likely but has not been previously studied. WHAT THIS STUDY ADDS:There is wide variation in testing, treatment, and overall resource utilization in management of the febrile young infant across all 3 age groups: #28, 29 to 56, and 57 to 89 days. There may be opportunities to improve care variation without compromising outcomes. abstract BACKGROUND AND OBJECTIVES: Variation in patient care or outcomes may indicate an opportunity to improve quality of care. We evaluated the variation in testing, treatment, hospitalization rates, and outcomes of febrile young infants in US pediatric emergency departments (EDs). METHODS:Retrospective cohort study of infants ,90 days of age with a diagnosis code of fever who were evaluated in 1 of 37 pediatric EDs between July 1, 2011 and June 30, 2013. We assessed patient-and hospital-level variation in testing, treatment, and disposition for patients in 3 distinct age groups: #28, 29 to 56, and 57 to 89 days. We also compared interhospital variation for 3-day revisits and revisits resulting in hospitalization. RESULTS:We identified 35 070 ED visits that met inclusion criteria. The proportion of patients who underwent comprehensive evaluation, defined as urine, serum, and cerebrospinal fluid testing, decreased with increasing patient age: 72.0% (95% confidence interval [CI], 71.0-73.0) of neonates #28 days, 49.0% (95% CI, 48.2-49.8) of infants 29 to 56 days, and 13.1% (95% CI, 12.5-13.6) of infants 57 to 89 days. Significant interhospital variation was demonstrated in testing, treatment, and hospitalization rates overall and across all 3 age groups, with little interhospital variation in outcomes. Hospitalization rate in the overall cohort did not correlate with 3-day revisits (R 2 = 0.10, P = .06) or revisits resulting in hospitalization (R 2 = 0.08, P = .09).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Variation in Care of the Febrile Young Infant <90 Days in US Pediatric Emergency Departments

et al. 2014

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“…Each of the four innate host factors studied exhibited unique spectrums of antimicrobial activity against the most common bacterial pathogens in neonatal infections, including E. coli, Enterococcus species, group B Streptococcus, H. influenzae, Klebsiella species, L. monocytogenes, P. aeruginosa, coagulase-negative Staphylococcus, and Staphylococcus aureus (35)(36)(37)(38)(39). These antimicrobial factors have complimentary activities, because each peptide has different bacterial spectrum and salt sensitivity.…”

Section: Discussionmentioning

confidence: 99%

Expression and Activity of β-Defensins and LL-37 in the Developing Human Lung

Starner

Agerberth

Guðmundsson

et al. 2005

The Journal of Immunology

110

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Immaturity of innate immunity contributes to the increased susceptibility of human neonates to infection. The lung is a major portal of entry for potential pathogens in the neonate, and human β-defensins (HBDs) and LL-37 participate in pulmonary innate immunity. We hypothesized that these antimicrobial factors would be developmentally regulated, expressed by neonatal pulmonary tissues, and participate in neonatal innate immunity. We found HBD-2 to be the predominant β-defensin in human neonatal lung. HBD-2 mRNA expression was developmentally regulated, induced by the proinflammatory factor IL-1β, and decreased by dexamethasone. Additionally, HBD-2 abundance in neonatal tracheal aspirates increased as a function of gestational age. HBD-1 had a lower level of expression compared with HBD-2 and was induced by dexamethasone. HBD-3 and LL-37 messages were not detected in airway epithelial cultures. Additionally, each antimicrobial peptide exhibited a unique spectrum of antimicrobial activity and salt sensitivity against bacteria commonly causing sepsis in the neonate. Lower levels of HBD-2 may be one factor contributing to the increased susceptibility of premature infants to pulmonary infections.

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“…There is limited evidence to determine the optimal age at which ampicillin therapy is no longer needed as a part of empirical antibiotic regimens. [4] Data from developed countries suggest that empirical ampicillin therapy is no longer needed after 1 month of age, [17] and there are limited data in Africa to support this practice; however, we have no data regarding the prevalence of LM infection at our institution.…”

Section: Researchmentioning

confidence: 91%

“…This was thought to be due to low availability of common potential food contamination sources. [16] The addition of ampicillin to a thirdgeneration cephalosporin for suspected neonatal sepsis and meningitis in neonates and infants aged <90 days seems to be appropriate, as most studies [4,7] show that LM is rare after 30 days of age. The question remains whether the empirical addi tion of ampicillin to a third-generation cephalosporin cannot be further restricted.…”

Section: Researchmentioning

confidence: 99%

A retrospective review of Listeria monocytogenes infection at Tygerberg Children’s Hospital, Cape Town, South Africa, from 2006 to 2016: Is empirical ampicillin still indicated after the first month of life?

2018

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Listeria monocytogenes (LM) infection is rare, but can cause severe infection in pregnant women and during the neonatal period. [1] LM is inherently resistant to some broad-spectrum antibiotics, including third-generation cephalosporins (e.g. ceftriaxone), which are commonly used as first-line antibiotics to treat suspected infection in the community. [2] For this reason, ampicillin is recommended for the empirical treatment of neonatal sepsis (ampicillin and gentamicin) [3] and neonatal meningitis (ampicillin and a thirdgeneration cephalosporin). Most treatment protocols recommend that ampicillin be added to a third-generation cephalosporin for the treatment of suspected serious bacterial infection in infants aged <3 months presenting with a fever, to ensure that cephalosporinresistant organisms, especially LM, are treated. [4] Two distinct clinical syndromes are seen in neonatal listeriosis. Early-onset infection in the first 7 days of life is associated with overwhelming sepsis and a high mortality rate. Late-onset infection occurring between 7 and 90 days has a lower mortality, but ~94% of patients have meningitis, [5] which is associated with poor neurodevelopmental outcomes. [6] Although the majority of neonatal cases present in the first 7 days of life, many guidelines still recommend additional LM cover up to 3 months of age. [1] A case series from the UK reported 362 infant cases of LM from 1970 to 2013, including sepsis and meningitis. [7] Of all cases of LM, 97% occurred in the first 90 days of life; of those occurring within the first 90 days, 99% presented in the first 30 days. Only 5 cases occurred in infants aged between 31 and 90 days in this 24-year period. Similarly, in a recent international review of LM infections, only 5 (of a total of 524) cases of LM were reported in infants aged 1-3 months. [1] There was a marked decrease in the incidence of pregnancy-related listeriosis in France from 1984 to 2006 related to the implementation of specific LM control measures at the food production level. [8] Data from 2006 to 2012 in the USA documented 181 cases of bacteraemia with no cases of LM in infants. [9] The World Health Organization recommends initial antibiotic therapy with a penicillin and an aminoglycoside or a third-generation cephalosporin for young infants (<60 days of age). [10] Current South African (SA) recommended guidelines for treatment of acute bacterial meningitis include addition of empirical ampicillin for infants aged <1 month of age until LM is excluded, [11] but in a number of centres, including ours, ampicillin is still added empirically to the treatment of suspected sepsis or meningitis in infants aged <2 months. There are limited published data on LM from SA. Two studies looking at paediatric LM were published between 25 and 50 years ago. A study done at Baragwanath Hospital in Johannesburg from August 1977 to April 1978 identified 14 cases of LM, 9 in neonates. All the neonates were aged <2 weeks at presentation. Four died, all within 3 days of birth or hospital admission. ...

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Ampicillin Use in Infant Fever

Abstract: The empirical use of ampicillin to cover febrile infants for L monocytogenes and enterococcal infections is most justifiable in the first month of life.

Cited by 22 publications

References 103 publications

Variation in Care of the Febrile Young Infant <90 Days in US Pediatric Emergency Departments

Variation in Care of the Febrile Young Infant <90 Days in US Pediatric Emergency Departments

Expression and Activity of β-Defensins and LL-37 in the Developing Human Lung

A retrospective review of Listeria monocytogenes infection at Tygerberg Children’s Hospital, Cape Town, South Africa, from 2006 to 2016: Is empirical ampicillin still indicated after the first month of life?

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Ampicillin Use in Infant Fever

Abstract: The empirical use of ampicillin to cover febrile infants for L monocytogenes and enterococcal infections is most justifiable in the first month of life.

Cited by 22 publications

References 103 publications

Variation in Care of the Febrile Young Infant &lt;90 Days in US Pediatric Emergency Departments

Variation in Care of the Febrile Young Infant &lt;90 Days in US Pediatric Emergency Departments

Expression and Activity of β-Defensins and LL-37 in the Developing Human Lung

A retrospective review of Listeria monocytogenes infection at Tygerberg Children’s Hospital, Cape Town, South Africa, from 2006 to 2016: Is empirical ampicillin still indicated after the first month of life?

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Variation in Care of the Febrile Young Infant <90 Days in US Pediatric Emergency Departments

Variation in Care of the Febrile Young Infant <90 Days in US Pediatric Emergency Departments