Antibiotic Resistance in Infants 2 months old

Researchers conducted a study about antibiotic resistance in infants under three months year old, specifically those experiencing uropathogens.  Within the study, previously healthy infants with urinary tract infections were observed.  Because there are limited data on antibiotic resistance of uropathogens in young infants, this study was of interest to the researchers.  The infants’ susceptibility to antibiotics was recorded, and this was conducted utilizing a urine sample or supra-pubic aspiration.

There has been a problem in which sepsis in neonates and UTIs in children are occurring due to antimicrobial resistance in Gram-negative bacteria (GNBs).  Many of the infants observed in this study who had UTIs were caused by GNBs that were resistant to several antibiotic classes.  The resistance rates observed were 73.7% to ampicillin, 22.1% cefazoline, 21.8% ampicillin/clavulanate, 7.8% cefuroxime, and 7% gentamicin.

The current standard treatment for infants with UTIs who are less than two months old is by IV.  It is an inpatient therapy, but there is evidence that there is equal efficacy in oral therapy.  Regardless of route of administration, gram-negative uropathogens express resistance even at two months of age.  This challenges the empirical therapy and compromises oral treatment options.  For this, antibiotic resistance and therapy choices should be monitored in infants to determine the correct antibiotic for them.

It was surprising to me how infants can experience antibiotic resistance prior to any exposure in the past.  Resistance is troublesome in any patient, but the idea of resistance in infants creates a different struggle.  What, as pharmacists can we do to assist in treating infants with antibiotic resistance?  When should the baby be screened for resistance?  Should it wait until the diagnosis and when the infant starts treatment?

Segal Z, Cohen MJ, Engelhard D, et al. Infants under two months of age with urinary tract infection are showing increasing resistance to empirical and oral antibiotics.  Acta Paediatricia. 2015:1-5.

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