Comparative Effectiveness and Safety of Empiric Ampicillin plus Gentamicin or Empiric Piperacillin-Tazobactam in the Neonatal Intensive Care Unit

Abstract

BACKGROUND: This study was designed to assess piperacillin tazobactam (PT) as an alternative to ampicillin and gentamicin (AG) in neonates with suspected systemic infection. METHODS: A retrospective, unmatched population of AG (2007-2009) and PT (2009-2012) exposed infants were evaluated for initial effectiveness, adverse events, and subsequent morbidities or mortality. Data included gestational age, birth weight, sex, Apgar score, length of hospital stay, glomerular filtration rate for days 1 and 2, duration on mechanical ventilation, duration on oxygen therapy, incidence of sepsis (blood or cerebrospinal fluid culture positive), incidence of ventilator associated pneumonia, and incidence of necrotizing enterocolitis. All positive blood cultures during the study period were reviewed. Data about specific microorganisms and sensitivity to antibiotics were RESULTS: No significant differences in demographics or initial Apgar scores were noted. There were no significant differences in systemic rash or diaper rash. PT was associated with higher glomerular filtration rate on day two. Four infants had early onset sepsis with ampicillin resistant E. coli. One of these, in the PT group, had intermediate sensitivity to gentamicin as well. CONCLUSION: Use of PT as the initial empiric antibiotic was not associated with increased adverse outcomes. The challenge of ampicillin resistant Escherichia coli should encourage others to consider this change.