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. 2022 Mar 1;41(3):263-271.
doi: 10.1097/INF.0000000000003380.

Antimicrobial Susceptibility Profiles Among Neonatal Early-onset Sepsis Pathogens

Dustin D Flannery  1   2   3 , Karen M Puopolo  1   2   3 , Nellie I Hansen  4 , Jeffrey S Gerber  2   3   5 , Pablo J Sánchez  6 , Barbara J Stoll  7 ; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Affiliations

Antimicrobial Susceptibility Profiles Among Neonatal Early-onset Sepsis Pathogens

Dustin D Flannery et al. Pediatr Infect Dis J. .

Abstract

Background: Empiric administration of ampicillin and gentamicin is recommended for newborns at risk of early-onset sepsis (EOS). There are limited data on antimicrobial susceptibility of all EOS pathogens.

Methods: Retrospective review of antimicrobial susceptibility data from a prospective EOS surveillance study of infants born ≥22 weeks' gestation and cared for in Neonatal Research Network centers April 2015-March 2017. Nonsusceptible was defined as intermediate or resistant on final result.

Results: We identified 239 pathogens (235 bacteria, 4 fungi) in 235 EOS cases among 217,480 live-born infants. Antimicrobial susceptibility data were available for 189/239 (79.1%) isolates. Among 81 Gram-positive isolates with ampicillin and gentamicin susceptibility data, all were susceptible in vitro to either ampicillin or gentamicin. Among Gram-negative isolates with ampicillin and gentamicin susceptibility data, 72/94 (76.6%) isolates were nonsusceptible to ampicillin, 8/94 (8.5%) were nonsusceptible to gentamicin, and 7/96 (7.3%) isolates were nonsusceptible to both. Five percent or less of tested Gram-negative isolates were nonsusceptible to each of third or fourth generation cephalosporins, piperacillin-tazobactam, and carbapenems. Overall, we estimated that 8% of EOS cases were caused by isolates nonsusceptible to both ampicillin and gentamicin; these were most likely to occur among preterm, very-low birth weight infants.

Conclusions: The vast majority of contemporary EOS pathogens are susceptible to the combination of ampicillin and gentamicin. Clinicians may consider the addition of broader-spectrum therapy among newborns at highest risk of EOS, but we caution that neither the substitution nor the addition of 1 single antimicrobial agent is likely to provide adequate empiric therapy in all cases.

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Conflict of interest statement

D.D.F. receives funding from the Agency for Healthcare Research and Quality (K08HS027468), two contracts from the Centers for Disease Control and Prevention (CDC), and the Children’s Hospital of Philadelphia. This study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development cooperative agreements, which provided infrastructure and study support to the NRN (grants UG1 HD27904, UG1 HD21364, UG1 HD27853, UG1 HD40492, UG1 HD27851, UG1 HD27856, UG1 HD68278, UG1 HD36790, UG1 HD27880, UG1 HD34216, UG1 HD68270, UG1 HD53109, UG1 HD53089, UG1 HD68244, UG1 HD68263, UG1 HD40689, UG1 HD21385, and UG1 HD87229 from the NICHD), the National Center for Advancing Translational Sciences, which provided infrastructure support to the NRN (grants UL1 TR1425, UL1 TR1117, UL1 TR454, UL1 TR1108, UL1 TR1085, UL1 TR442, UL1 TR1449, and UL1 TR42 from NCATS), and the CDC, which provided study support to the NRN (Interagency Agreement no. 14FED1412884 from the CDC). None of the authors has conflicts of interest to declare relevant to this study.

References

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