Feldman EA, et al. – This study outlined the hospital differences in empirical antibiotic use, bacterial epidemiology, and antimicrobial susceptibility for common antibiotic regimens among young infants with urinary tract infection (UTI), bacteremia, or bacterial meningitis. Accumulated data represented that empirical antibiotic use differed across regionally diverse US children’s hospitals in infants <90 days old with UTI, bacteremia, or meningitis. It was found that antimicrobial susceptibility to common antibiotic regimens was similar across hospitals, and adding ampicillin to a third–generation cephalosporin minimally improves coverage. These findings supported the incorporation of empirical antibiotic recommendations into national guidelines for infants with suspected bacterial infection.

Methods

• The authors collected and reviewed the medical records from infants <90 days old presenting to 8 US children’s hospitals with UTI, bacteremia, or meningitis.
• To identify cases and empirical antibiotic use, they applied the Pediatric Health Information System database.
• They reviewed medical record to analyze infection, pathogen, and antimicrobial susceptibility patterns.
• They compared hospital–level differences in antimicrobial use, pathogen, infection site, and antimicrobial susceptibility.

Results

• In total 470 infants with bacterial infections were identified: 362 (77%) with UTI alone and 108 (23%) with meningitis or bacteremia. Infection type did not differ across hospitals (P = .85).
• Findings showed that empirical antibiotic use varied across hospitals (P < .01), although antimicrobial susceptibility patterns for common empirical regimens were similar.
• A third–generation cephalosporin would have empirically treated 90% of all ages, 89% in 7– to 28–day–olds, and 91% in 29– to 89–day–olds. 
• It was suggested that the addition of ampicillin would have improved coverage in only 4 cases of bacteremia and meningitis.
• Ampicillin plus gentamicin would have treated 95%, 89%, and 97% in these age groups, respectively.