Antibiotic Use in Newborns with Transient Tachypnea of the Newborn.

2013

Weintraub AS, Cadet CT, Perez R, Delorenzo E, Holzman IR, Stroustrup A.

Source

Division of Newborn Medicine, Kravis Children's Hospital, Mount Sinai Medical Center, New York, N.Y., USA.

Abstract

Background: Initiation of empiric antibiotic treatment for possible early-onset sepsis is recommended for late preterm and term neonates with respiratory distress. There is no evidence base to this approach. 

Objectives: To determine the incidence of adverse infectious events in neonates with transient tachypnea of the newborn (TTN) managed with a risk-factor-based restrictive antibiotic use policy. 

Methods: This is a single institution retrospective cohort study of neonates with primary diagnosis of TTN between 2004 and 2010. The relationship between antibiotic exposure and infectious outcomes during the neonatal hospitalization was evaluated. An infectious outcome was defined as pneumonia, bacteremia, clinical sepsis, or death. Analysis included t test, χ(2) test, and analysis of variance as appropriate. 

Results: 745 neonates with TTN met inclusion criteria. None of the 494 antibiotic-naive infants, and 212 of the 251 antibiotic-exposed infants had identifiable risk factors for sepsis. No infectious outcomes occurred in infants who did not receive antibiotics. Eight neonates with TTN received full antibiotic treatment for early-onset sepsis. Each was appropriately identified for early receipt of antibiotics based on historical or clinical risk factors for early-onset sepsis. 

Conclusions: This study suggests that empiric postnatal antibiotictreatment may not be warranted for late preterm and term infants with TTN in the absence of specific infectious risk factors.

PubMed

Different impact of the appropriateness of empirical antibiotics for bacteremia among younger adults and the elderly in the ED.

Sept 2012

Lee CC, Chang CM, Hong MY, Hsu HC, Ko WC.

Source

Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan.

Abstract

OBJECTIVES:

 To investigate the clinical impact of age on bacteremia among adults visiting the emergency department (ED).

METHODS:

 Bacteremic adults visiting the ED from January 2008 to December 2008 were identified retrospectively. Demographic characteristics, severity, bacteremic pathogens with in vitro susceptibility, antimicrobial agents, and outcomes determined from chart records were analyzed as a case-control study.

RESULTS:

 Of 518 eligible bacteremic adults, 288 fifty six percent elderly patients greater then 65 years old were case patients and 230 younger patients, less then 65 years  were regarded as control patients. The 28-day mortality rate was higher in the case patients than that in the control patients (11.8% vs 6.1%, P = .02). The proportion of inappropriate empirical antibiotic therapy between the survivors and nonsurvivors was similar in control patients (69.4% vs 64.3%, P = .77); but for the case patients, the proportion of inappropriate empirical antibiotic therapy in the survivors was lower than that in the non-survivors (27.6% vs 44.1%, P = .04). Of note, inappropriate empirical antibiotic therapy was also one of independent risk factors of 28-day mortality by the multivariate analyses in the case patients (odds ratio [OR] 3.65; P = .049). Other independent predictors of 28-day mortality in case patients included a high Pittsburgh bacteremia score (≥4 points; OR 22.16; P < .001), bacteremia due to foci other than urinary tract infection (OR 9.07; P = .002), malignancy (OR 10.87; P < .001), coronary artery disease (OR 5.68; P = .01), and high serum creatinine (>1.5 mg/dL; OR 3.44; P = .04).

CONCLUSIONS:

For bacteremic adults, this study demonstrated the impact of inappropriate empirical antibiotic therapy on patients' outcome in the elderly was greater than that in the younger adults.

PubMed