Gram-Negative Bacilli in Infants Hospitalized in The Neonatal Intensive Care Unit.
BACKGROUND
Gram-negative bacilli (GNB) account for a significant burden of infection and colonization in neonatal intensive care units (NICUs), and antibiotic resistance among these pathogens is of increasing concern.


METHODS
A prospective cohort study was performed in 4 NICUs between May 2009 and April 2012. The body sites from which GNB were isolated, antimicrobial susceptibilities of the GNB isolated, and antimicrobial therapy were assessed.


RESULTS
Attending neonatologists treated 3.0% (188 of 6184) of eligible infants for GNB infection; 23% of 214 GNB isolates were nonsusceptible to antimicrobial agents, including gentamicin (14.8%), piperacillin-tazobactam (9.9%), third-generation cephalosporin (7.0%), and/or carbapenem agents (4.5%). Gentamicin was the most commonly used antibiotic overall, and much of its use was empiric. However, third-generation cephalosporin agents and cefepime were used more commonly as targeted therapy for identified Gram-negative pathogens.


CONCLUSIONS
One-quarter of the GNB isolates were nonsusceptible to ≥1 antibiotic. Antimicrobial stewardship strategies for reducing antimicrobial use in NICUs should be implemented.
Department of Pediatrics, Columbia University Medical Center, New York, New York.
Sameer J
SJ
Patel
Department of Pediatrics, Columbia University Medical Center, New York, New York.
Nicole
N
Green
Department of Pediatrics, Columbia University Medical Center, New York, New York.
Sarah A
SA
Clock
Department of Pediatrics, Section of Neonatology, Christiana Care Health System, Newark, Delaware.
David A
DA
Paul
Department of Pediatrics, Weill Cornell Medical Center, New York, New York.
Jeffrey M
JM
Perlman
Department of Pediatrics, Children's Hospital of Philadelphia, Pennsylvania.
Theoklis
T
Zaoutis
School of Nursing, Columbia University Medical Center.
Yu-Hui
YH
Ferng
Department of Pediatrics, Columbia University Medical Center, New York, New York.
Luis
L
Alba
School of Nursing, Columbia University Medical Center.
Haomiao
H
Jia
School of Nursing, Columbia University Medical Center.
Elaine L
EL
Larson
Department of Pediatrics, Columbia University Medical Center, New York, New York.|Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York.
Lisa
L
Saiman
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology*; D024881:Drug Resistance, Bacterial; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies
D000900:Anti-Bacterial Agents
antimicrobial stewardship; bloodstream infections; healthcare-associated infections; neonate; resistance