Five years of experience with the exclusive use of amikacin in a neonatal intensive care unit.
From November 1, 1980, to December 31, 1985, 3959 infants were admitted to the neonatal intensive care unit and 2385 infants (60%) received 2791 courses of aminoglycoside therapy. Aminoglycoside use totaled 16,279 patient days of which 16,070 (98.7%) were with amikacin. From November 1, 1980, to January 31, 1983, 1017 pairs of pre- and posttreatment endotracheal or pharyngeal specimens yielded 318 Gram-negative bacteria isolates. From November 1, 1980, to December 31, 1985, Gram-negative bacteria were isolated from 381 clinical specimens. Of the 318 surveillance and 380 clinical isolates tested, 285 (90%) and 358 (94%), respectively, were susceptible to amikacin. Amikacin resistance did not increase during the study. Amikacin-resistant organisms were isolated more frequently from patients receiving multiple courses than those receiving single courses of amikacin and resistant organisms were not usually found before the administration of amikacin. None of the 15 amikacin-resistant isolates made 6'-N-aminoglycoside acetyltransferase and 3 isolates took up only small amounts of radiolabeled amikacin, suggesting that resistance was due to decreased permeability. The extensive use of amikacin in a neonatal intensive care unit for over 5 years did not result in an increase of amikacin-resistant Gram-negative bacteria.
D000583:Amikacin / Q000494:pharmacology / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D004352:Drug Resistance, Microbial; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008826:Microbial Sensitivity Tests
D000583:Amikacin