Wide use of broad-spectrum antibiotics in very low birth weight infants with spontaneous focal intestinal perforation-is it really justified?

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  • Additional Information
    • Source:
      Publisher: Springer Heidelberg Country of Publication: Germany NLM ID: 0365307 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1439-0973 (Electronic) Linking ISSN: 03008126 NLM ISO Abbreviation: Infection Subsets: MEDLINE
    • Publication Information:
      Publication: 2011- : Heidelberg : Springer Heidelberg
      Original Publication: München, Verlagsgesellschaft Otto Spatz.
    • Subject Terms:
      Infant, Very Low Birth Weight* ; Anti-Bacterial Agents*/therapeutic use ; Intestinal Perforation*; Humans ; Infant, Newborn ; Male ; Female ; Prospective Studies ; Carbapenems/therapeutic use ; Carbapenems/pharmacology ; Germany ; Intensive Care Units, Neonatal ; Cohort Studies
    • Abstract:
      Purpose: Very low birth weight (VLBW) infants are at a risk of spontaneous focal intestinal perforation (FIP). Treatment includes supportive care, antibiotics, and drainage with/without surgery. Broad-spectrum antibiotic agents like carbapenems are applied frequently, although their use is not well-supported by the limited evidence of causal pathogens. We hypothesize that the use of carbapenems may not be necessary in VLBW infants with FIP. Our primary objective was to evaluate the antimicrobial use in VLBW infants with FIP in a cohort of the German Neonatal Network (GNN). The secondary objective was to characterize a subset in detail as a benchmark for future targets of stewardship.
      Methods: Data on VLBW infants with FIP was collected prospectively within the GNN, a collaboration of 68 neonatal intensive care units (NICU). With regards to the primary objective, patient characteristics and antimicrobial treatment were extracted from the predefined GNN database. To address our secondary objective, an additional on-site assessment of laboratory and microbiological culture results were performed.
      Results: In the GNN cohort, 613/21,646 enrolled infants (2.8%) developed FIP requiring surgery. They were frequently treated with carbapenems (500/613 (81.6%)) and vancomycin (497/613 (81.1%)). In a subset of 124 VLBW infants, 77 (72.6%) had proof of gram-positive bacteria in the abdominal cavity, coagulase-negative staphylococci (CoNS) predominantly. Despite the low prevalence of gram-negative bacteria (n = 6 (4.8%)), the combination of meropenem and vancomycin was prescribed most frequently (n = 96 (78.0%)).
      Conclusion: The use of carbapenems as broad-spectrum antimicrobials agents might not be justified in most VLBW infants with FIP. Knowledge on the development of the neonatal gut microbiota, local resistance patterns and individual microbiological findings should be taken into consideration when implementing antimicrobial stewardship programs (ASPs).
      (© 2024. The Author(s).)
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    • Contributed Indexing:
      Keywords: Antimicrobial stewardship; Carbapenem; Focal intestinal perforation; Vancomycin; Very low birthweight infants
    • Accession Number:
      0 (Anti-Bacterial Agents)
      0 (Carbapenems)
    • Publication Date:
      Date Created: 20240418 Date Completed: 20241023 Latest Revision: 20241026
    • Publication Date:
      20241026
    • Accession Number:
      PMC11499452
    • Accession Number:
      10.1007/s15010-024-02257-2
    • Accession Number:
      38634989