title: Timely empiric antimicrobials are associated with faster microbiologic clearance in preterm neonates with late-onset bloodstream infections.
abstract: OBJECTIVE
  The impact of timely empiric antimicrobial therapy on neonates is unclear. Our aim was to examine rates of effective timely empiric antimicrobial therapy on preterm neonates, together with the associated outcomes.
  
  
  METHODS
  We performed a single-centre retrospective study of preterm infants (<32 weeks of gestational age) with a late-onset (>72 h of age) bloodstream infection (BSI). Empiric antimicrobial administration took place before the results of blood culture were available and its timing was determined by the electronic medical records.
  
  
  RESULTS
  Our cohort (n = 105) was predominantly female (59%) and black (83%) with a mean (SD) gestational age of 27.4 (2.3) weeks and birthweight of 948 (335) g. Effective empiric antimicrobials were initiated in 114 (69%) of 165 BSI episodes, and a third of the BSIs without empiric antimicrobials were found to be fungal. Both antimicrobial timing (r = 0.27, p = 0.002) and fungal organism (r = 0.35, p = 0.0001) showed significant correlations and were independently associated with time to clearance. Neither variable was associated with survival or length of stay.
  
  
  CONCLUSIONS
  Two-thirds of preterm infants with late-onset BSIs received effective empiric antimicrobials. Timely empiric antimicrobials were associated with shorter time to microbiologic clearance. These data suggest the need for standardised guidelines and quality improvement initiatives.
authors.affiliation: Department of Pediatrics, Wayne State University, Detroit, MI, USA.
authors.forename: Girija
authors.initials: G
authors.lastname: Natarajan
authors.forename: Lea
authors.initials: L
authors.lastname: Monday
authors.forename: Terri
authors.initials: T
authors.lastname: Scheer
authors.forename: Mirjana
authors.initials: M
authors.lastname: Lulic-Botica
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D016469:Fungemia / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy* / Q000382:microbiology; D008297:Male; D012189:Retrospective Studies
chemical_list: D000890:Anti-Infective Agents
keywords: Antimicrobials; Bloodstream infection; Neonates; Preterm