1
|
Wade KC, Greenberg RG, Benjamin DK, Chen LLH, Vo B, Ang BL, Boutzoukas A, Zimmerman K, Clark RH, Cohen-Wolkowiez M, Le J. Postdiscontinuation Antibiotic Exposure in Hospitalized Infants at Risk for Late-onset Sepsis in the Neonatal Intensive Care Unit. Pediatr Infect Dis J 2024:00006454-990000000-00898. [PMID: 38900075 DOI: 10.1097/inf.0000000000004426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
BACKGROUND In the neonatal intensive care unit, infants are at risk for late-onset sepsis. When blood cultures are negative, antibiotic stewardship efforts encourage stopping antibiotics, yet the duration of therapeutic exposure after the last dose is unknown. METHODS This retrospective cohort study of simulated antibiotic exposures used published population pharmacokinetic models within drug-specific neonatal intensive care unit cohorts of preterm and term infants, postnatal age 7-60 days and exposed to cefepime, piperacillin-tazobactam or tobramycin. Monte Carlo simulations (NONMEM 7.3) were used to predict steady-state exposures after a 72-hour antibiotic course per Neofax dosing. Exposure was assessed relative to drug-specific minimum inhibitory concentration (MIC) targets between 1 and 16 mcg/mL for Pseudomonas and Enterobacteriaceae species. Postdiscontinuation antibiotic exposure (PDAE) was defined as the time from the last dose to when antibiotic concentration decreased below a specific MIC. RESULTS Piperacillin-tazobactam, cefepime and tobramycin cohorts included infants with median gestation age 29, 32 and 32 weeks and postnatal age 17, 19 and 15 days, respectively. The mean PDAE was 19-68 hours, depending on the specific antibiotic/MIC combination. PDAE was longer for infants <28 days old and preterm (vs. term) infants. Cefepime exhibited the longest mean PDAE of 68 hours for Enterobacteriaceae MIC 1. Piperacillin mean PDAE was 25 hours for Enterobacteriaceae MIC 8. Tobramycin had a short mean PDAE of 19 hours. CONCLUSIONS Piperacillin and cefepime exposures remained therapeutic long after the expected 8- to 12-hour dosing interval. PDAE is an important consideration for antibiotic stewardship among hospitalized infants, particularly premature infants and those within 1 month postbirth.
Collapse
Affiliation(s)
- Kelly C Wade
- From the Department of Pediatrics, University of Pennsylvania School of Medicine
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rachel G Greenberg
- Department of Pediatrics, Duke University Medical Center
- Duke Clinical Research Institute, Durham, North Carolina
| | - Daniel K Benjamin
- Department of Pediatrics, Duke University Medical Center
- Duke Clinical Research Institute, Durham, North Carolina
| | - Lydia Li-Hui Chen
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, California
| | - Brandon Vo
- University of California Riverside, Riverside, California
| | - Berwyn Liselle Ang
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, California
| | - Angelique Boutzoukas
- Department of Pediatrics, Duke University Medical Center
- Duke Clinical Research Institute, Durham, North Carolina
| | - Kanecia Zimmerman
- Department of Pediatrics, Duke University Medical Center
- Duke Clinical Research Institute, Durham, North Carolina
| | - Reese H Clark
- MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, Florida
| | - Michael Cohen-Wolkowiez
- Department of Pediatrics, Duke University Medical Center
- Duke Clinical Research Institute, Durham, North Carolina
| | - Jennifer Le
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, California
| |
Collapse
|
2
|
Mok JH, Song J, Hahn WH, Cho S, Park JM, Koh J, Kim H, Kang NM. Biochemical Profiling of Urine Metabolome in Premature Infants Based on LC-MS Considering Maternal Influence. Nutrients 2024; 16:411. [PMID: 38337695 PMCID: PMC10857068 DOI: 10.3390/nu16030411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
In this study, Liquid Chromatography-Mass Spectrometry (LC-MS)-based metabolomics profiling was conducted to elucidate the urinary profiles of premature infants during early and late postnatal stages. As a result, we discovered significant excretion of maternal drugs in early-stage infants and identified crucial metabolites like hormones and amino acids. These findings shed light on the maternal impact on neonatal metabolism and underscore the beneficial effects of breastfeeding on the metabolism of essential amino acids in infants. This research not only enhances our understanding of maternal-infant nutritional interactions and their long-term implications for preterm infants but also offers critical insights into the biochemical characteristics and physiological mechanisms of preterm infants, laying a groundwork for future clinical studies focused on neonatal development and health.
Collapse
Affiliation(s)
- Jeong-Hun Mok
- Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Republic of Korea;
| | - Junhwan Song
- Department of Pediatrics, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (J.S.); (J.K.); (H.K.)
| | - Won-Ho Hahn
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Seoul 04401, Republic of Korea;
| | - Seonghyeon Cho
- Basil Biotech, Incheon 22002, Republic of Korea; (S.C.); (J.-M.P.)
| | - Jong-Moon Park
- Basil Biotech, Incheon 22002, Republic of Korea; (S.C.); (J.-M.P.)
| | - Jiwon Koh
- Department of Pediatrics, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (J.S.); (J.K.); (H.K.)
| | - Ho Kim
- Department of Pediatrics, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (J.S.); (J.K.); (H.K.)
| | - Nam Mi Kang
- Department of Nursing, Research Institute for Biomedical & Health Science, Konkuk University, Chungju-si 27478, Republic of Korea
| |
Collapse
|
3
|
Kumar R, Setiady I, Bultmann CR, Kaufman DA, Swanson JR, Sullivan BA. Implementation of a 24-hour empiric antibiotic duration for negative early-onset sepsis evaluations to reduce early antibiotic exposure in premature infants. Infect Control Hosp Epidemiol 2023; 44:1308-1313. [PMID: 36278513 DOI: 10.1017/ice.2022.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE Antibiotic exposure increases the risk of morbidity and mortality in premature infants. Many centers use at least 48 hours of antibiotics in the evaluation of early-onset sepsis (EOS, <72 hours after birth), yet most important pathogens grow within 24 hours. We investigated the safety and efficacy of reducing empiric antibiotic duration to 24 hours. DESIGN Quality improvement study. SETTING A tertiary-care neonatal intensive care unit. PATIENTS Inborn infants <35 weeks gestational age at birth (ie, preterm) admitted January 2019 through December 2020. INTERVENTION In December 2019, we changed the recommended duration of empiric antibiotics for negative EOS evaluations from 48 hours to 24 hours. RESULTS Patient characteristics before and after the intervention were similar. After the intervention, 71 preterm infants (57%) with negative EOS evaluations received ≤24 hours of antibiotics, an increase from 15 (10%) before the intervention. These 71 infants comprised 77% of infants with negative EOS blood cultures after excluding those treated as clinical sepsis (≥5 days of antibiotics). For all negative EOS blood cultures, the mean treatment duration decreased by 0.5 days from 3.9 days to 3.4 days. This finding equated to 2.4 fewer antibiotic days per 100 patient days for negative EOS blood cultures but similar antibiotic days per 30 patient days (7.2 days vs 7.5 days). This measure did not change over time. Subsequent sepsis evaluations <7 days after a negative EOS blood culture did not increase. Excluding contaminants, the median time to positivity was 13.2 hours (range, 8-23) in 8 positive blood cultures. CONCLUSION Implementation of a 24-hour antibiotic course for negative EOS evaluations safely reduced antibiotic exposure in 77% of infants <35 weeks gestational age at birth in whom EOS was ruled out. All clinically significant pathogens grew within 24 hours.
Collapse
Affiliation(s)
- Rupin Kumar
- Division of Neonatology, Department of Pediatrics, University of Kentucky School of Medicine, Lexington, Kentucky
| | - Initha Setiady
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Charlene R Bultmann
- Division of Neonatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - David A Kaufman
- Division of Neonatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Jonathan R Swanson
- Division of Neonatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Brynne A Sullivan
- Division of Neonatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| |
Collapse
|
4
|
Mohan B, Singh G, Chauhan A, Pombeiro AJL, Ren P. Metal-organic frameworks (MOFs) based luminescent and electrochemical sensors for food contaminant detection. JOURNAL OF HAZARDOUS MATERIALS 2023; 453:131324. [PMID: 37080033 DOI: 10.1016/j.jhazmat.2023.131324] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/10/2023] [Accepted: 03/29/2023] [Indexed: 05/03/2023]
Abstract
With the increasing population, food toxicity has become a prevalent concern due to the growing contaminants of food products. Therefore, the need for new materials for toxicant detection and food quality monitoring will always be in demand. Metal-organic frameworks (MOFs) based on luminescence and electrochemical sensors with tunable porosity and active surface area are promising materials for food contaminants monitoring. This review summarizes and studies the most recent progress on MOF sensors for detecting food contaminants such as pesticides, antibiotics, toxins, biomolecules, and ionic species. First, with the introduction of MOFs, food contaminants and materials for toxicants detection are discussed. Then the insights into the MOFs as emerging materials for sensing applications with luminescent and electrochemical properties, signal changes, and sensing mechanisms are discussed. Next, recent advances in luminescent and electrochemical MOFs food sensors and their sensitivity, selectivity, and capacities for common food toxicants are summarized. Further, the challenges and outlooks are discussed for providing a new pathway for MOF food contaminant detection tools. Overall, a timely source of information on advanced MOF materials provides materials for next-generation food sensors.
Collapse
Affiliation(s)
- Brij Mohan
- School of Science, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China; Centro de Química Estrutural, Institute of Molecular Sciences, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal.
| | - Gurjaspreet Singh
- Department of Chemistry & Centre for Advanced Studies in Chemistry, Panjab University, Chandigarh 160014, India
| | - Archana Chauhan
- Department of Chemistry, Kurukshetra University, Kurukshetra, Haryana 136119, India
| | - Armando J L Pombeiro
- Centro de Química Estrutural, Institute of Molecular Sciences, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal.
| | - Peng Ren
- School of Science, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China.
| |
Collapse
|
5
|
Developmental Pharmacokinetics of Antibiotics Used in Neonatal ICU: Focus on Preterm Infants. Biomedicines 2023; 11:biomedicines11030940. [PMID: 36979919 PMCID: PMC10046592 DOI: 10.3390/biomedicines11030940] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/22/2023] Open
Abstract
Neonatal Infections are among the most common reasons for admission to the intensive care unit. Neonatal sepsis (NS) significantly contributes to mortality rates. Empiric antibiotic therapy of NS recommended by current international guidelines includes benzylpenicillin, ampicillin/amoxicillin, and aminoglycosides (gentamicin). The rise of antibacterial resistance precipitates the growth of the use of antibiotics of the Watch (second, third, and fourth generations of cephalosporines, carbapenems, macrolides, glycopeptides, rifamycins, fluoroquinolones) and Reserve groups (fifth generation of cephalosporines, oxazolidinones, lipoglycopeptides, fosfomycin), which are associated with a less clinical experience and higher risks of toxic reactions. A proper dosing regimen is essential for effective and safe antibiotic therapy, but its choice in neonates is complicated with high variability in the maturation of organ systems affecting drug absorption, distribution, metabolism, and excretion. Changes in antibiotic pharmacokinetic parameters result in altered efficacy and safety. Population pharmacokinetics can help to prognosis outcomes of antibiotic therapy, but it should be considered that the neonatal population is heterogeneous, and this heterogeneity is mainly determined by gestational and postnatal age. Preterm neonates are common in clinical practice, and due to the different physiology compared to the full terms, constitute a specific neonatal subpopulation. The objective of this review is to summarize the evidence about the developmental changes (specific for preterm and full-term infants, separately) of pharmacokinetic parameters of antibiotics used in neonatal intensive care units.
Collapse
|