1. Dr Lucinda Perkins Supervisor: Dr Jean Matthes 08/10/14
Review of Second Line Antibiotic Choice on Singleton NICU and Telephone Survey of UK Practice
Dr Lucinda Perkins
Supervisor: Dr Jean Matthes
08/10/14

2. Introduction Sepsis major cause of mortality & morbidity
Empirical antibiotic choice based on likely causative organisms
Managing and preventing outbreaks of Gram- negative infections in UK NICU’s recommends ‘audit antibiotic use and translate findings into practice change’ ADC Fetal Neonatal Ed 2013;98:F549–F553
National standard for first line antibiotic:
CG149 Antibiotics for early-onset neonatal infection: NICE guideline
LOS pathogens more varied

3. Aims & Methods Review of 2nd line antibiotic choice:
Flucloxacillin and Gentamicin: WITHOUT central line
Cefotaxime and Vancomycin: WITH central line
Retrospective analysis of sensitivities of all positive blood cultures since ESBL outbreak in late 2011
Use of microbiology & Indigo reporting systems
Comparison of practise to similar UK units via telephone survey of all level 3 units
Via microbiologist Ann LewisPrint-outs of detailed sensitivities from Microbiology used for original subset (excluding majority of Staph/Strep)
Indigo sensitivity reports used for all others
Anthony et al
Particular relevance to Singleton
ESBL Ecoli outbreak in 2011
One strain of ESBL producing E.coli contributed to the deaths of 2 premature infants
Reference:
‘An outbreak of ESBL-producing E.coli in a NICU’
Infant volume 10, issue 1, 2014

4. Results 64 sepsis episodes 121 (10.3%) POSITIVE 82 blood cultures
39 (32.3%) Contaminants*
*identified using VON critera
64 sepsis episodes
59 patients
82 blood cultures
98 organisms
8% (5/59) patients had >1 sepsis episode
24% (14/59) patients had > 1 positive culture
12% (10/98)of blood cultures had multiple organisms
Earliest growth Day 0, latest day 102, Mean day 15

5. Gram Stain of Organisms4%
28%
68%
3 patients with 5 blood cultures positive for Candida
4 Candida Albicans, 1 Candida sp. Only stated
2 sepsis episodes involved ONLY candida n = 62

6. Gram Positive
Gram Negative

7. Gram Positive Sensitivities

8. Gram Negative Sensitivities

9. Sensitivity to Dual Therapy
Antibiotic
Sensitive
Resistant
Not reported
Flucloxacillin & Gentamicin
47%
27%
26%
Cefotaxime & Vancomycin
42% 3%
55%
Gentamicin & Vancomycin
73%
19% 8%

10. Survey of 2nd Line Antibiotics in Level 3 Units Nationwide (37/45)
‘Cef and Vanc’ includes Cefotaxime x2, Ceftazidime x3

11. Survey of 2nd Line Antibiotics in Babies with Central Line

12. Conclusions
Significantly more organisms sensitive to Vancomycin than the Penicillins
Sensitivity to Cefotaxime largely unknown
Recommend change for babies with central access to Vancomycin and Gentamicin
Re-audit bloods culture sensitivities & side effects in 6 months
Emphasis must remain on recognising early signs of sepsis with prompt administration of IV antibiotics
Changing from Gentamicin to Cefotaxime may provide less cover

13. Reserve Slides The following 5 slides are reserve slides
Please note these slides are only included in case a question is asked requiring clarification.
They will not be included in the 12 slide presentation

14. Sensitivities by Sepsis Episode

15. Resistances by Organism (n=73)

16. Revised Resistances

17. Gentamicin Resistance
3 sepsis episodes (excluding CONS)
Early onset: Ecoli x1 (ESBL)
Late onset: Acinetobacter x1, Enterobacter Cloacae x1,

18. Second Line Antibiotics