Antibiotic Therapy In Infants Research Articles

Impact of Early Oral Antibiotic Therapy in Infants With Bacteremic Urinary Tract Infections.

To determine the effect of early conversion to oral antibiotics in infants ≤90 days with gram-negative bacteremia and concomitant urinary tract infection on hospital length of stay (LOS) and 30-day revisits for urinary tract infection. This retrospective cohort study included infants ≤ 90 days who had concomitant positive blood and urine cultures with gram-negative bacteremia at 22 hospitals from January 1, 2002 through January 31, 2020. Early oral conversion was defined as a maximum intravenous (IV) duration of 4 days. We conducted a noninferiority test to compare early oral conversion to long IV therapy. A propensity score framework was used to assess comparisons in survey-weighted regression models using matched weights. Among 174 infants, 73 infants received early oral conversion. The LOS was shorter in infants receiving early oral conversion compared to long IV therapy (median 2 days [interquartile range 2, 3] vs 4 days [3, 5]), descriptively (P < .001) and in noninferiority analysis (ratio = 0.43; 90% CI 0.35, 0.53, P < .001). Thirty-day revisits occurred in 5 of 174 (2.8%) of total patients. Early oral conversion did not meet our noninferiority criteria for the 30-day revisits (odds ratio: 4.22, 90%; confidence interval: 0.83, 21.34, P = .91). Early oral conversion was associated with shorter LOS. The rate of 30-day revisit rates overall was low.

1140. Impact of a Rapid Molecular Bloodstream Diagnostic Test on Optimal Antibiotic Use in Infants

Abstract Background Rapid molecular bloodstream diagnostics have been shown to decrease time-to-optimal antibiotic therapy in adult and pediatric patients. The purpose of the study was to compare the time-to-optimal antimicrobial therapy both pre-and post- implementation of rapid diagnostic testing in infants. Methods This was a single-center quasi-experimental study conducted from December 2018 to December 2020 at Children’s Hospital New Orleans. A rapid, multiplex polymerase chain reaction bloodstream diagnostic was implemented in January 2019. Antimicrobial Stewardship performed a daily review of all antimicrobials during both periods and made recommendations when necessary. The primary outcome was the difference in time-to-optimal therapy. Secondary outcomes included time-to-effective therapy, 30-day all-cause mortality rate, 30-day recurrent bacteremia rate, and time-to-microbiologic clearance. Patients were excluded if they had an unrelated concomitant infection, withdrawal of care before the result, bacteria not identified by the panel, or were over 6 months of age. Results Thirty-five and forty-three patients met inclusion criteria pre-and post-implementation. The median post-natal age was 2 months and median PRISM score was 12 in both groups. Median time-to-optimal therapy was 53.1 hours in the pre-intervention and 24.4 hours in the post-intervention group (-28.7 hours, P = 0.03). Median time-to-effective therapy was 0 and 1.4 hours, respectively (+1.4 hours, P = 0.02). There was no significant difference in 30-day all-cause mortality (3 vs. 4 patients, P = 0.62), 30-day recurrent bacteremia (0 vs. 2 patients, P = 0.2), or microbiologic clearance (37.3 vs. 26.2 hours, P = 0.09). Conclusion Implementation of a rapid, multiplex bloodstream diagnostic lead to a significant decrease in time-to-optimal antibiotic therapy in infants when compared to standard microbiological techniques. Disclosures All Authors: No reported disclosures

The use of antibiotics in newborns: effects on gastrointestinal microbiome and long-term results

A balanced gastrointestinal microbiome is crucial for the development of the immune system. The use of antibiotic therapy in infants often leads to intestinal dysbiosis. This article presents a convincing argument that the use of antibiotics in infants and young children affects their health in the future. The purpose of antibiotic therapy in childhood should be well thought out, because its negative effect on the gastrointestinal tract the ability to cause diarrhoea, has been proven, and, in addition, antibiotics have long-term effects: overweight, irritable bowel syndrome (IBS), allergic diseases. Conclusion: clinicians should weigh the need and consequences of using antibiotics in infancy and early childhood.

Evaluating the Need for Prophylactic Antibiotic Therapy in Infants with Transient Tachypnea of the Newborn: A Triple-Blind Randomized Clinical Trial Study

Background Transient tachypnea of the newborn (TTN) is a respiratory disorder caused by delay in the evacuation of the lung fluids. Prophylactic antibiotic therapy is recommended for the risk of sepsis. We aimed to evaluate the effect of the prophylactic antibiotic in infants with TTN. Materials and Methods This randomized clinical trial study was conducted on all infants, admitted to TTN at Fatemiyeh Hospital, Hamadan, Iran, in 2017. Infants with TTN were randomly stratified into two groups based on whether they received antibiotic or not. Then, the clinical outcomes and laboratory results were examined in the two groups.The categorical data were compared with Chi-square test and the continuous data with t-test using Stata software version 14.0. Results Out of 100 term and late preterm infants were admitted to TTN.No significant difference was found between two groups in terms of gender (p = 0.228), gestational age (p = 0.728), birth weight (p = 0.974)and other baseline characteristics. Results revealed that no case of sepsis, pneumonia and death were seen in the group received prophylactic antibiotic and the other group did not receive it, but the admission time was lower in infants, who did not receive antibiotic (137.76 ±32.42 versus 159.36± 33.85, p= 0.001). Conclusion This study showed that antibiotic prescription in TTNs infants without perinatal risk factors has no impact on the disease outcome, and prophylactic antibiotic can be avoided.However, more evidence based on large sample size is required.

Changes in Pulmonary Function and Controlled Ventilation-High Resolution CT of Chest After Antibiotic Therapy in Infants and Young Children with Cystic Fibrosis.

Infants with cystic fibrosis (CF) develop early progressive lung disease which may be asymptomatic. Infant pulmonary function tests (IPFT) and controlled ventilation-high resolution computed tomography (CV-HRCT) of chest can detect early asymptomatic lung disease. It is not well established that these objective measures can detect changes in lung disease after clinical interventions. The purpose of this study was to evaluate usefulness of IPFT and CV-HRCT to detect changes in lung disease after intravenous (IV) antibiotic therapy in infants with early CF-related lung disease. IPFTs and CV-HRCT done before and after 2 weeks of IV antibiotics in infants at our institution over the last 12 years were compared. CV-HRCTs were compared using the modified Brody scoring system. The sample included 21 infants, mean age 85.2 ± 47.6 weeks. Mean change in weight was 0.4 ± 0.38 kg (p = 0.001). Significant changes in IPFT included mean % predicted FEV(0.5) (+13.5 %, p = 0.043), mean %FEF(25-75) (+30.2 %, p = 0.008), mean %RV/TLC (-11.2 %, p = 0.008), and mean %FRC/TLC (-4.5 %, p = 0.001). Total Brody scores improved from a median of 10 to 5 (p < 0.001) as did mean scores for airway wall thickening (p = 0.050), air trapping (p < 0.001), and parenchymal opacities (p = 0.003). IPFT and CV-HRCT can be used as objective measures of improvement in lung disease for infants with CF treated with antibiotics.

IN VITRO ACTIVITY OF COMBINATIONS AMINOGLYCOSIDES AND PENICILLINS AGAINST GROUP B STREPTOCOCCI

In recent years group B streptococci (GBS) have become one of the most common etiologic agents in neonatal infections. In vitro studies indicate that GBS are susceptible to concentrations of penicillin and ampicillin readily achievable in serum. However, fatality rates, often in excess of 50%, occur despite antibiotic therapy. Ampicillin (AMP), penicillin G (Pen G), tobramycin (TOB), kanamycin (KAN), gentamicin (GEN), and amikacin (AMI) were evaluated for their in vitro activity against GBS. Checkerboard titrations of the combination of aminoglycoside and penicillin or ampicillin were performed. Ninety percent of the fifteen isolates tested showed indifference to the aminoglycoside-ampicillin combination, whereas ten percent had an additive effect. Eighty percent of the isolates showed indifference to the aminoglycoside-penicillin combination, with twenty percent having an additive effect. No synergy or antagonism was found using the various amino-glycosides with either penicillin or ampicillin. Although synergy was not demonstrated, it appears that initial empiric combination antibiotic therapy in infants suspected of having sepsis should not compromise the outcome of those with GBS sepsis.

A Rational Approach to Antibiotic Therapy in Infants and Children

A Rational Approach to Antibiotic Therapy in Infants and Children