Late-onset infection and the role of antibiotic prescribing policies.
OBJECTIVE
Late-onset infection is a significant cause of morbidity and mortality in low-birth-weight and premature infants. Empirical antibiotic treatment is used as infants can deteriorate rapidly without treatment. Current data on the epidemiology of late-onset infection, the types of antibiotics used, duration of antibiotic use, and antibiotic prescribing policies are reviewed.


RESULTS
Epidemiological data on late-onset sepsis is dominated by information concerning developed countries; large prospective data collections have been set up in many such countries. Recent data indicate that late-onset sepsis occurs in one-fifth of very-low-birth-weight infants. There are increasing concerns regarding antibiotic resistance. Antibiotic regimens that do not include third-generation cephalosporins produce less resistance. Strategies of antibiotic rotation have not been documented as producing a marked effect on the development of resistant micro-organisms, but there is a lack of randomized trials. Recommendations for preventing the spread of vancomycin-resistant enterococci, produced by the Hospital Infection Control Practices Advisory Committee, have been shown to be effective in a number of situations. Recent reports have documented the success of multidisciplinary, systems-orientated approaches for reducing neonatal nosocomial infection.


CONCLUSIONS
Antibiotic prescribing policies have an important role to play in the treatment of late-onset neonatal infection. There is enough evidence to state that narrow-spectrum antibiotics should be used wherever possible and that potent broad-spectrum antibiotics should be kept in reserve. Ongoing prospective surveillance of infection rates, micro-organisms, resistance and antibiotic use is essential.
Gordon
Adrienne
A
Department of Neonatal Medicine, Royal Prince Alfred Hospital, New South Wales, Australia. adrienne.gordon@email.cs.nsw.gov.au
Isaacs
David
D
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology*; D024881:Drug Resistance, Bacterial; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D019102:Infant, Very Low Birth Weight; D013997:Time Factors
D000900:Anti-Bacterial Agents