Several studies have demonstrated an association between maternal antibiotic therapy and early-onset of infection in preterm infants with resistant pathogens.
Dr. Tiffany S. Glasgow and colleagues from University of Utah, Salt Lake City, evaluated the impact of intrapartum antibiotic exposure on late-onset (7 to 90 days postpartum) serious bacterial infections in 90 infected infants and 92 matched controls without serious bacterial infections.
More infected infants than controls had been exposed to intrapartum antibiotics (41% versus 27%, respectively), the authors note, and infected infants were five times as likely as control infants to have been exposed to broad-spectrum antibiotics.
Forty-one percent of the bacterial isolates from infected infants were resistant to ampicillin, the report indicates, but 65% of the isolates from infected infants with intrapartum antibiotic exposure were ampicillin-resistant.
The relationship between infection with an ampicillin- resistant organism and intrapartum antibiotic exposure was significant for urinary tract infections and other serious bacterial infections, including meningitis, omphalitis, and bacteremia without urinary tract infection, the researchers note.
“Taking into account the potential limitations of our study, we believe that our findings have uncovered a potentially important, unintended consequence of the widespread use of broadspectrum intrapartum antibiotics to prevent early-onset group B streptococcal infection,” the investigators conclude.
“Physicians who are responsible for choosing an intrapartum antibiotic agent should be encouraged to select penicillin whenever possible,” they add, “and those who are responsible for evaluating infants for a possible serious bacterial infection should determine whether the infant was exposed to intrapartum antibiotics.”
“Because infants with a history of intrapartum antibiotic exposure and suspicion of meningitis are at increased risk for infection with an ampicillin- resistant pathogen, clinicians should consider adding a third-generation cephalosporin to the standard ampicillin and gentamicin regimen as the initial choice,” the authors suggest.
- pediatrics.aappublications.org/cgi/ content/abstract/111/5/964
- Pediatrics 2005;116:696-702.
This article appeared in Pathways to Family Wellness magazine, Issue #08.
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