title: Serious bacterial infections in hospitalized febrile infants aged 90 days or younger: the traditional combination of ampicillin and gentamicin is still appropriate.
abstract: BACKGROUND
  A change in the bacterial epidemiology of infantile serious bacterial infection (SBI) has raised concerns regarding the appropriate empirical antibiotic therapy.
  
  
  OBJECTIVE
  To describe the epidemiological features of SBI in febrile infants in order to elucidate the appropriate empirical regimens.
  
  
  METHODS
  From 2005 to 2009, clinical and laboratory data were prospectively collected for all infants aged ≤ 90 days who were hospitalized for fever.
  
  
  RESULTS
  Of the 1584 febrile infants who met the study criteria, 149 (9.4%) had a culture-proven SBI: urinary tract infection in 128 (86%), urinary tract infection with bacteraemia in 11 (7%), bacteraemia in 7 (5%), enteritis with bacteraemia in 2 (1.3%), and meningitis in 1 (0.7%). Ninety-one percent of cases were caused by Gram-negative bacteria, mostly Escherichia coli (72%). Among the causative Gram-positive bacteria were Enterococcus spp. (4%) and group B Streptococcus (0.7%); no cases of Listeria monocytogenes infection were identified. Sixty-one percent of the causative bacteria were resistant to ampicillin. According to in vitro susceptibility testing, the combination of ampicillin and gentamicin provided appropriate antibiotic coverage.
  
  
  CONCLUSIONS
  Despite changes in the epidemiology of infantile SBI, the traditional combination of ampicillin and gentamicin is still appropriate for empirical treatment of febrile infants aged ≤ 90 days.
authors.affiliation: Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petach Tikva, Tel Aviv, Israel. ashkenazi.liat@gmail.com
authors.forename: Liat
authors.initials: L
authors.lastname: Ashkenazi-Hoffnung
authors.forename: Gilat
authors.initials: G
authors.lastname: Livni
authors.forename: Jacob
authors.initials: J
authors.lastname: Amir
authors.forename: Efraim
authors.initials: E
authors.lastname: Bilavsky
mesh_terms: D000667:Ampicillin / Q000494:pharmacology / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology*; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005839:Gentamicins / Q000494:pharmacology / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D000667:Ampicillin