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Original Investigation
November 9, 2020

Antibiotic Susceptibility of Escherichia coli Among Infants Admitted to Neonatal Intensive Care Units Across the US From 2009 to 2017

Author Affiliations
  • 1Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 2Division of Neonatology, Children’s Hospital of Philadelphia Newborn Care at Pennsylvania Hospital, Philadelphia
  • 3Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 4Center for Pharmacoepidemiology Research and Training, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 5Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
  • 6Division of Pediatric Infectious Diseases, Department of Pediatrics, C. S. Mott Children’s Hospital/University of Michigan, Ann Arbor
  • 7Healthcare Analytics Unit, Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 8Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 9Division of Pediatric Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
JAMA Pediatr. 2021;175(2):168-175. doi:10.1001/jamapediatrics.2020.4719
Key Points

Question  To what antibiotics are Escherichia coli isolates susceptible among infants admitted to neonatal intensive care units, and how has this susceptibility changed over time?

Findings  In this cohort study of 721 infants with E coli infection admitted to 69 neonatal intensive care units across the US from 2009 to 2017, a mean of 66.8% of isolates from blood, cerebrospinal fluid, and urine specimens were not susceptible to ampicillin, 16.8% were not susceptible to aminoglycosides, and 5.0% had an extended-spectrum β-lactamase phenotype.

Meaning  These findings may inform empirical antibiotic prescribing for newborns across the US.

Abstract

Importance  Escherichia coli is a leading cause of serious infection among term and preterm newborn infants. Surveillance of antibiotic susceptibility patterns of E coli among infants admitted to neonatal intensive care units should inform empirical antibiotic administration.

Objective  To assess the epidemiologic characteristics and antibiotic susceptibility patterns of E coli in infants admitted to neonatal intensive care units in the US over time.

Design, Setting, and Participants  This retrospective cohort study used the Premier Health Database, a comprehensive administrative database of inpatient encounters from academic and community hospitals across the US. Participants included newborn infants admitted to centers contributing microbiology data from January 1, 2009, to December 31, 2017, with E coli isolated from blood, cerebrospinal fluid, or urine cultures. Data were collected and analyzed from December 1, 2018, to November 30, 2019.

Main Outcomes and Measures  Changes in annual antibiotic susceptibility of E coli during the study period. The proportion of infants with nonsusceptible organisms (resistant or intermediate susceptibility) in antibiotic categories by year, birth weight, infection source, and timing of infection and patient and center characteristics associated with neonatal E coli infection and antibiotic susceptibility were assessed.

Results  A total of 721 infants (434 male [60.2%]; median age at E coli infection, 14 days [interquartile range, 1-33 days]) from 69 centers had at least 1 episode of E coli infection and available susceptibility results. No significant changes were observed over time in the overall annual proportions of antibiotic nonsusceptibility to ampicillin (mean [SD], 66.8% [1.5%]; range, 63.3% to 68.6%; estimated yearly change, −0.28% [95% CI, −1.75% to 1.18%]), nonsusceptibility to aminoglycosides (mean [SD], 16.8% [4.5%]; range, 10.7% to 23.2%; estimated yearly change, −0.85% [95% CI, −1.93% to 0.23%]), or extended-spectrum β-lactamase phenotype (mean [SD], 5.0% [3.7%]; range, 0% to 11.1%; estimated yearly change, 0.46% [95% CI, −0.18% to 1.11%]). No isolates with nonsusceptibility to carbapenems were identified. Among 218 infants with early-onset infection, 22 (10.1%) had isolates with nonsusceptibility to both ampicillin and gentamicin, the antibiotics most commonly administered to newborns as empirical therapy.

Conclusions and Relevance  In this cohort study, nonsusceptibility to commonly administered antibiotics was found in substantial proportions of neonatal E coli isolates, with no significant change from 2009 to 2017. These findings may inform empirical antibiotic choices for newborn infants.

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