Antibiotic prescribing in neonatal sepsis: an Australian nationwide survey

McMullan, Brendan; Cooper, Celia; Spotswood, Naomi; James, Rodney; Jones, Cheryl; Konecny, Pamela; Blyth, Christopher; Karen, Thursky

doi:10.1136/bmjpo-2020-000643

Cited by 14 publications

(15 citation statements)

References 27 publications

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“…The neonatal period is a very vulnerable time in life in which sepsis or meningitis is a frequent primary cause of death [ 1 , 2 , 3 ]. The Global Burden of Disease study estimated that 2202 neonates for every 100,000 live births develop neonatal sepsis, equating to three million cases of neonatal sepsis annually, with a mortality rate of 11–19% [ 4 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Variations in Antibiotic Use and Sepsis Management in Neonatal Intensive Care Units: A European Survey

et al. 2021

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Management of neonatal sepsis and the use of antimicrobials have an important impact on morbidity and mortality. However, there is no recent background on which antibiotic regimens are used in different European neonatal intensive care units (NICUs). Our study aimed to describe the use of antibiotics and other aspects of early- and late-onset sepsis (EOS and LOS, respectively) management by European NICUs. We conducted an online survey among NICUs throughout Europe to collect information about antibiotic stewardship, antibiotic regimens, and general aspects of managing neonatal infections. NICUs from up to 38 European countries responded, with 271 valid responses. Most units had written clinical guidelines for EOS (92.2%) and LOS (81.1%) management. For EOS, ampicillin, penicillin, gentamicin, and amikacin were the most commonly used antibiotics. Analysis of the combinations of EOS regimens showed that the most frequently used was ampicillin plus gentamicin (54.6%). For LOS, the most frequently used antibiotics were vancomycin (52.4%), gentamicin (33.9%), cefotaxime (28%), and meropenem (15.5%). Other aspects of the general management of sepsis have also been analyzed. The management of neonatal sepsis in European NICUs is diverse. There was high self-reported adherence to the local clinical guidelines. There was homogeneity in the combination of antibiotics in EOS but less in LOS.

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Section: Introductionmentioning

confidence: 99%

“…Data across Europe on the current practice of antimicrobial use in neonatal sepsis and the general management of sepsis are also limited [ 1 , 24 , 25 ]. However, previous studies have described some variability in the dosage of commonly used antibiotics in the neonatal period and the existence of clinical guidelines [ 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Variations in Antibiotic Use and Sepsis Management in Neonatal Intensive Care Units: A European Survey

et al. 2021

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“…The administration of linezolid was secondly classified as adequate or inadequate independently by two pediatricians, following previously published Australian guidelines [ 12 ]. Briefly, indication was considered as adequate if linezolid was prescribed for a Gram positive infection with either resistance to other antibiotics (including beta-lactams and vancomycin), or if there was a persistent bacteremia despite vancomycin therapy with appropriate serum level (15–20 mg/L) and removal of central venous line (or impossibility to remove it), or also if there was a contraindication to vancomycin (renal failure).…”

Section: Methodsmentioning

confidence: 99%

Increasing use of linezolid in a tertiary NICU during a 10-year period: reasons and concerns for the future

Matrat

Plaisant

Barreto

et al. 2020

Antimicrob Resist Infect Control

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Background Linezolid has been increasingly used in tertiary NICUs. The objectives of this study were to explore the indications of these linezolid prescriptions, to analyze a possible misuse and to provide solutions to avoid such misuse. Methods A monocentric retrospective cohort study included all neonates hospitalized in one tertiary NICU between January 1st, 2010 and December 31st, 2019 and who received at least one administration of linezolid. These data were confronted to epidemiological and antibiotic use data from the same NICU. Two independent pediatricians secondarily classified linezolid uses as adequate or not. Results During the study period, 66 infections in 57 patients led to linezolid use. Most patients were pre-term and 21 patients (37%) died. Infections were mainly related to methicillin-resistant coagulase negative staphylococci and were frequently either pneumoniae (35%) or isolated bacteremia (48%), including 25 persistent bacteremia (64% of the 39 bacteremia). Need for a better tissue distribution or first-line treatment failure were the main reasons to initiate linezolid. Linezolid was administered for a median duration of 7 [3;10] days. No side effects were reported. Twenty-two (33%) of the 66 linezolid prescriptions were retrospectively classified as inadequate. Conclusions A rapid increase in linezolid prescriptions has been observed in our tertiary NICU, from 2014 to 2019, with 33% inadequate uses. This worrisome trend should lead to search for therapeutic alternatives and to work on antibiotic stewardship to prevent the emergence of new antimicrobial bacterial resistance.

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“…3 Perinatal infection has been reported as the primary cause in 10.6% of Australian neonatal deaths, so it remains important to understand sepsis and its treatments. 4 The Sepsis-3 consensus definitions for adults define sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection, and septic shock as a subset of sepsis in which underlying circulatory and cellular metabolism abnormalities are profound enough to substantially increase mortality. 5 However, variable definitions are used in the neonatal intensive care setting and there is no clear consensus on the definition or progression of neonatal sepsis and septic shock.…”

Section: What This Paper Addsmentioning

confidence: 99%

Progression from sepsis to septic shock and time to treatments in preterm infants with late‐onset sepsis

Gorantiwar

Waal

2021

J Paediatrics Child Health

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Aim: Late-onset sepsis (LOS) in preterm infants can progress rapidly from minimal clinical signs and symptoms to septic shock which is associated with high mortality. The aim of this study was to describe the progression from sepsis to septic shock and evaluate our management performance with emphasis on time to treatments. Methods: This was a retrospective observational study including preterm infants ≤32 weeks gestation with LOS and septic shock defined as the requirement of fluids and vasopressors. Physiological changes and time to first diagnostics and treatments were determined from the point of first appearance of clinical signs and symptoms of sepsis (T ONSET ). Results: During the 10-year observational period, 279 infants developed LOS and 25 (8.9%) progressed to septic shock. The median (interquartile range) time from T ONSET to blood culture, administering antibiotics, fluid bolus and vasopressors was 8.4 (4.8-12.2), 9.2 (5.6-12.4), 14.6 (9.5-34.5) and 22.0 (14.6-44.7) h, respectively. Hypotension and raised lactate were prominent physiological changes in the progression to septic shock. Fluid bolus and vasopressors were administered when blood pressure was 20 and 41% below to what was normal before the infant became unwell. Vasopressors significantly increased blood pressure and heart rate. Mortality rate was 40% with no difference in time to treatments between survivors and non-survivors. Conclusion: Clinical recognition of the onset of sepsis in preterm infants remains difficult and contributes to delay of treatment. Once recognised, early administration of antibiotics, fluid bolus and vasopressors should be prioritised.

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Antibiotic prescribing in neonatal sepsis: an Australian nationwide survey

Abstract: Objective To evaluate quality and variation in antibiotic prescribing for neonatal sepsis.

Cited by 14 publications

References 27 publications

Variations in Antibiotic Use and Sepsis Management in Neonatal Intensive Care Units: A European Survey

Variations in Antibiotic Use and Sepsis Management in Neonatal Intensive Care Units: A European Survey

Increasing use of linezolid in a tertiary NICU during a 10-year period: reasons and concerns for the future

Progression from sepsis to septic shock and time to treatments in preterm infants with late‐onset sepsis

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