Management of antibiotic-resistant infection in the newborn

Abstract

We are inexorably entering an era where a wide range of multiply antibiotic-resistant bacteria are commonplace. Until recently, multiresistance was mainly seen in Gram-positive bacteria. However, vancomycin remains adequate as a treatment of most infections with these bacteria. The potential threat from vancomycin-resistant bacteria has never fully materialised, and now there is a growing number of new anti-Gram-positive antibiotics. Of these, there is sufficient experience of using linezolid and daptomycin in neonates for these drugs to be recommended for some specific indications. The recent rapid international spread of multiresistant Gram-negative bacteria, including carbapenem-resistant strains, is much more ominous. Treatment options are extremely limited, which has prompted renewed interest in older and more toxic antibiotics such as colistin. However, the optimal management of serious neonatal infections with these bacteria remains to be determined.

Neonatal infections due to multi-resistant strains: Epidemiology, current treatment, emerging therapeutic approaches and prevention

“…Even though an increase in vancomycin MIC values, within the susceptible range, has been registered among isolates of MRSA, CONS or S. aureus strains vancomycin-intermediate or vancomycin-resistant haven't been documented in the NICU population [16,17].…”

“…Enterococci are uncommon pathogens in neonatal settings, even though, ampicillin-resistant, and more recently, an increasing rate of infections due to VRE has been described in children and neonates [15][16][17]. In particular in the US the rate of vancomycin resistance among Enetrococcus faecium isolates is estimated around 60% [9].…”

“…In addition they could be multidrug-resistant, for example resistant to gentamicin, rifampin, erythromycin, and clindamycin [16][17][18].…”

Population Pharmacokinetics of Ciprofloxacin in Neonates and Young Infants Less than Three Months of Age

“…It is not considered a first-line treatment in current guidelines for neonatal sepsis but is used in severe infections caused by Enterobacter spp. resistant to standard treatment and when there is a major risk of meningitis and secondary cerebral abscess (2,3). In a recent European survey, ciprofloxacin was used "off-label" in 25% of neonatal intensive care units, mainly in cases of culture-proven bacterial sepsis due to multidrug-resistant organisms that are sensitive to ciprofloxacin (4).…”

Short versus Long Infusion of Meropenem in Very-Low-Birth-Weight Neonates

“…atients in the neonatal intensive care unit (NICU), especially premature newborns with immature organ systems, frequently suffer nosocomial infections caused by microorganisms resistant to narrow-spectrum antibiotics like ampicillin and gentamicin and thus require the introduction of agents with a wider spectrum of activity (7,14,29). Meropenem is active against a wide variety of Gram-negative and Gram-positive microorganisms and offers good penetration of body fluids and tissues (1,9).…”