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Bloodstream Infections in a Neonatal Intensive-Care Unit: 12 Years' Experience With an Antibiotic Control Program

Published online by Cambridge University Press:  02 January 2015

Leandro Cordero ,
Mercedes Sananes  and
Leona W. Ayers
Leandro Cordero*
Affiliation:
Department of Pediatrics, The Ohio State University Medical Center, Columbus, Ohio
Mercedes Sananes
Affiliation:
Department of Pediatrics, The Ohio State University Medical Center, Columbus, Ohio
Leona W. Ayers
Affiliation:
Allied Medical Professions, The Ohio State University Medical Center, Columbus, Ohio
*
Director of Newborn Services, Professor of Pediatrics and Obstetrics, The Ohio State University Medical Center, Pediatrics Department, N118 Doan Hall, 410 W 10th Ave, Columbus, OH 43210-1228
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Abstract

Objective:

To assess the prevalence of gram-positive coccal (GPC), gram-negative bacillary (GNB), and fungal bloodstream infections (BSIs) during a 12-year period in which a consistent antibiotic treatment protocol was in place; to evaluate the efficacy of these antibiotic policies in relation to treatment, to the emergence of bacterial or fungal resistance, and to the occurrence of infection outbreaks or epidemics.

Study Design:

Case series.

Methods:

Demographic, clinical, and bacteriological information from 363 infants born during 1986 through 1991 and 1992 through 1997 who developed 433 blood-culture-proven BSIs was analyzed. Early-onset BSIs were defined as those infections discovered within 48 hours of birth, and late-onset BSIs as those that occurred thereafter. Suspected early-onset BSIs were treated with ampicillin and gentamicin, and suspected late-onset BSIs with vancomycin and gentamicin. Antibiotics were changed on the basis of organism antimicrobial susceptibility.

Results:

Early-onset BSIs were noted in 52 of 21,336 live births and 40 of 20,402 live births during 1986 through 1991 and 1992 through 1997, respectively. GPC (83% due to group B streptococcus [GBS]) accounted for approximately one half of early-onset BSI cases and GNB (68% Enterobacteriaceae) for the remainder. Early-onset GBS declined from 24 to 11 cases (P =.04) and late-onset BSI increased from 111 to 230 cases (P<.01) from the first to the last study period. Sixty-eight percent of late-onset BSIs were due to GPC (primarily coagulase-negative Staphylococcus), 18% to GNB, and 14% to fungus. Over the study period, Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, and Pseudomonas aeruginosa isolated from the newborn intensive-care unit (unlike those strains from other hospital units) remained fully susceptible to ceftazidime and gentamicin. Although the hospitalwide prevalence of methicillin-resistant Staphylococcus aureus increased, all 17 newborn BSI cases were due to methicillin-sensitive strains. Prevalence of methicillin-resistant coagulase-negative Staphylococcus increased, although all strains remained vancomycin-susceptible, as did the 16 Enterococcus faecalis isolates. All fungi recovered (from 48 patients) were susceptible to amphotericin.

Conclusion:

We observed a decrease in the prevalence of early-onset BSIs due to GBS and an increase in late-onset BSIs due to GPC, GNB, and fungi. The combination of ampicillin and gentamicin for suspected early-onset BSIs and vancomycin and gentamicin for late-onset BSIs has been successful for treatment of individual patients without the occurrence of infection outbreaks or the emergence of resistance. Controlled antibiotic programs and periodic evaluations based on individual unit and not on hospitalwide antibiograms are advisable.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 4 , April 1999 , pp. 242 - 246
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

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