Chu et al reported risk factors for the initially inadequate antibiotic therapy of a neonate wth Gram-negative bacteremia. These can help to identify a neonate at risk for a worse outcome. The authors are from Chang Gung Memorial Hospital and Yunlin Chang Gung Memorial Hospital in Taiwan.
Patient selection: neonate with Gram-negative bacteremia in the NICU
Inadequate empirical antibiotic therapy: failure to receive any antibiotic agent to which the causative microorganisms were susceptible within 24 hours of blood culture sampling
Frequency of occurrence: about 20%
Frequency of inadequate antibiotic therapy due to antibiotic resistance: 88%
Risk factors:
(1) bacteremia with Pseudomonas aeruginosa (OR 20.8)
(2) bacteremia with extended spectrum beta-lactamase (ESBL) producing bacteria (OR 18.4)
(3) previous exposure to a third-generation cephalosporin within 1 month (OR 2.5)
Neonates who received initially inadequate antibiotic therapy had:
(1) higher rates of major organ damage (20% vs 7%)
(2) higher rates of prolonged (> 3 days) ileus and/or feeding intolerance (40% vs 18%)
(3) higher rates of infectious complications (25% vs 9%)
(4) higher rate of progression to severe sepsis or septic shock
(5) higher mortality (23% vs 11%)
