Chu et al reported risk factors for the initially inadequate antibiotic therapy of a neonate wth Gram-negative bacteremia. These can help to identify a neonate at risk for a worse outcome. The authors are from Chang Gung Memorial Hospital and Yunlin Chang Gung Memorial Hospital in Taiwan.

Patient selection: neonate with Gram-negative bacteremia in the NICU


Inadequate empirical antibiotic therapy: failure to receive any antibiotic agent to which the causative microorganisms were susceptible within 24 hours of blood culture sampling


Frequency of occurrence: about 20%


Frequency of inadequate antibiotic therapy due to antibiotic resistance: 88%


Risk factors:

(1) bacteremia with Pseudomonas aeruginosa (OR 20.8)

(2) bacteremia with extended spectrum beta-lactamase (ESBL) producing bacteria (OR 18.4)

(3) previous exposure to a third-generation cephalosporin within 1 month (OR 2.5)


Neonates who received initially inadequate antibiotic therapy had:

(1) higher rates of major organ damage (20% vs 7%)

(2) higher rates of prolonged (> 3 days) ileus and/or feeding intolerance (40% vs 18%)

(3) higher rates of infectious complications (25% vs 9%)

(4) higher rate of progression to severe sepsis or septic shock

(5) higher mortality (23% vs 11%)

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