Fellow: Jane Im, MD, Pediatric Hospital Medicine Fellow, Cleveland Clinic
Article: Feldman EA, McCulloh RJ, Myers AL, et al. Empiric antibiotic use and susceptibility in infants with bacterial infections: a multicenter retrospective cohort study. Hosp Pediatr. 2017;7(8)
Summary: The authors conducted a multicenter retrospective cohort study to assess the use of empiric antibiotics, bacterial epidemiology and antimicrobial susceptibility among young infants <90 days with UTIs, bacteremia or bacterial meningitis. Across the 8 US children's hospitals included in this study, infection type (p=0.85) and antimicrobial susceptibility were similar. Although a third-generation cephalosporin without the addition of ampicillin would have empirically treated 90% of the infants enrolled, empiric antibiotic use within institutions varied (p<0.01). Results of this study could be used to support development of a national guideline for infants with suspected bacterial infection that would include recommendations for an empiric antibiotic regimen.
What are the key strengths of the article?
This was a multicenter cohort study including 8 pediatric academic medical centers from different geographical regions. A previously validated method was used to identify the study cohort of 470 infants. Bacterial infections that were identified were secondarily confirmed with culture.
Are there any limitations or flaws in the article?
Results were obtained from free standing academic medical centers. Therefore, the primary limitation of this study is that the results may not be applicable to community and outpatient settings. There was also a smaller sample size of patients identified with meningitis only limiting assessment of susceptibility patterns amongst this group.
What is the major takeaway message?
A third-generation cephalosporin provides adequate empiric coverage in a majority of UTIs and bacteremia in infants <90 days old amongst 8 hospitals nationwide. Ampicillin with gentamicin may be used as an alternative in neonates without gram-negative meningitis.
Describe how this article should impact our practice:
It is always beneficial to continually evaluate choice of antibiotics for perceived risks and benefits. However, if not concerned for gram negative meningitis, a third-generation cephalosporin or ampicillin/gentamicin would cover a majority of infants <90 days. A national empiric antibiotic recommendation would limit over or under-treatment of patients leading to appropriate antibiotic stewardship.
Article: Feldman EA, McCulloh RJ, Myers AL, et al. Empiric antibiotic use and susceptibility in infants with bacterial infections: a multicenter retrospective cohort study. Hosp Pediatr. 2017;7(8)
Summary: The authors conducted a multicenter retrospective cohort study to assess the use of empiric antibiotics, bacterial epidemiology and antimicrobial susceptibility among young infants <90 days with UTIs, bacteremia or bacterial meningitis. Across the 8 US children's hospitals included in this study, infection type (p=0.85) and antimicrobial susceptibility were similar. Although a third-generation cephalosporin without the addition of ampicillin would have empirically treated 90% of the infants enrolled, empiric antibiotic use within institutions varied (p<0.01). Results of this study could be used to support development of a national guideline for infants with suspected bacterial infection that would include recommendations for an empiric antibiotic regimen.
What are the key strengths of the article?
This was a multicenter cohort study including 8 pediatric academic medical centers from different geographical regions. A previously validated method was used to identify the study cohort of 470 infants. Bacterial infections that were identified were secondarily confirmed with culture.
Are there any limitations or flaws in the article?
Results were obtained from free standing academic medical centers. Therefore, the primary limitation of this study is that the results may not be applicable to community and outpatient settings. There was also a smaller sample size of patients identified with meningitis only limiting assessment of susceptibility patterns amongst this group.
What is the major takeaway message?
A third-generation cephalosporin provides adequate empiric coverage in a majority of UTIs and bacteremia in infants <90 days old amongst 8 hospitals nationwide. Ampicillin with gentamicin may be used as an alternative in neonates without gram-negative meningitis.
Describe how this article should impact our practice:
It is always beneficial to continually evaluate choice of antibiotics for perceived risks and benefits. However, if not concerned for gram negative meningitis, a third-generation cephalosporin or ampicillin/gentamicin would cover a majority of infants <90 days. A national empiric antibiotic recommendation would limit over or under-treatment of patients leading to appropriate antibiotic stewardship.