JOURNAL REVIEWS
June 1, 1999 2 minutes read
JOURNAL REVIEWS
Cordero L, Sananes M, Ayers LW. Bloodstream infections in a neonatal intensive-care unit: 12 years’ experience with an antibiotic control program. Infect Control Hosp Epidemiol 1999; 20:242-246.
Antibiotic policies based on drug susceptibility information from individual hospital units may prove more effective than those that use data from the hospital at large or from national antibiotic resistance data, the authors report.
"Focused microbiological surveillance by hospital units is more valuable, because hospital-wide data may suggest antibiotic resistance where there is none or mask severe resistance problems unique to some care units," they conclude.
They assessed the prevalence of gram-positive coccal, gram-negative bacillary, and fungal bloodstream infections (BSIs) during a 12-year period in which a consistent antibiotic treatment protocol was in place in a neonatal intensive care unit (NICU).
Over the study period, Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, and Pseudomonas aeruginosa isolated from the newborn intensive care unit (unlike those strains from other hospital units) remained fully susceptible to ceftazidime and gentamicin. While hospitalwide prevalence of methicillin-resistant Staphylococcus aureus increased, all 17 newborn BSI cases were due to methicillin-sensitive strains. Prevalence of methicillin-resistant coagulase-negative Staphylococcus increased, although all strains remained vancomycin-susceptible, as did the 16 Enterococcus faecalis isolates. All fungi recovered (from 48 patients) were susceptible to amphotericin.
The combination of ampicillin and gentamicin for suspected early-onset BSI and vancomycin and gentamicin for suspected late-onset BSI has not resulted in antimicrobial resistance in the NICU. Successful treatment of individual BSI cases was facilitated by the preservation of antimicrobial susceptibilities, the authors found.
"Our controlled antibiotic program limited the empirical use of cephalosporins in treatment of early- and late-onset sepsis and avoided resistance to this class of antimicrobials," they note. "The absence of serious outbreaks or epidemics highlights the usefulness of controlled antibiotic programs and the need for periodic reevaluations of antimicrobial resistance based on individual care units and not on hospital-wide or national data."
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